Provider Demographics
NPI:1831340942
Name:EXCELL MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:EXCELL MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-281-0890
Mailing Address - Street 1:5284 COMMERCE DR
Mailing Address - Street 2:SUITE C-164
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7930
Mailing Address - Country:US
Mailing Address - Phone:801-281-0890
Mailing Address - Fax:801-281-0910
Practice Address - Street 1:5284 COMMERCE DR
Practice Address - Street 2:SUITE C-164
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7930
Practice Address - Country:US
Practice Address - Phone:801-281-0890
Practice Address - Fax:801-281-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty