Provider Demographics
NPI:1720251119
Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Entity Type:Organization
Organization Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, PHYS SERV & EXEC DIR, EHPP
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-830-8500
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:ROOM 503
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-1544
Mailing Address - Fax:724-527-5026
Practice Address - Street 1:520 JEFFERSON AVE
Practice Address - Street 2:ROOM 503
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2538
Practice Address - Country:US
Practice Address - Phone:724-527-1544
Practice Address - Fax:724-527-5026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-08
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009992L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001562186Medicaid
PA001562186Medicaid