Provider Demographics
NPI:1205275492
Name:EXCELTH, INCORPORATED
Entity type:Organization
Organization Name:EXCELTH, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:TREGRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-524-1210
Mailing Address - Street 1:1515 POYDRAS ST
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-3723
Mailing Address - Country:US
Mailing Address - Phone:504-524-1210
Mailing Address - Fax:504-524-1491
Practice Address - Street 1:9900 LAKE FOREST BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2609
Practice Address - Country:US
Practice Address - Phone:504-524-1210
Practice Address - Fax:504-524-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty