Provider Demographics
NPI:1760493514
Name:EXCEL MEDICAL, LLC
Entity Type:Organization
Organization Name:EXCEL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:STEELE
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-864-0036
Mailing Address - Street 1:1312 HEATHERLOCH DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6444
Mailing Address - Country:US
Mailing Address - Phone:704-864-0036
Mailing Address - Fax:704-867-8367
Practice Address - Street 1:1312 HEATHERLOCH DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6444
Practice Address - Country:US
Practice Address - Phone:704-864-0036
Practice Address - Fax:704-867-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3515171040417332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045TROtherBLUE CROSS BLUE SHIELD
NC7704023Medicaid
NC7704023Medicaid