Provider Demographics
NPI:1164792404
Name:EXCELTH, INCORPORATED
Entity type:Organization
Organization Name:EXCELTH, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TENNESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-658-2785
Mailing Address - Street 1:1111 NEWTON ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 NEWTON STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2500
Practice Address - Country:US
Practice Address - Phone:504-524-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Single Specialty