Provider Demographics
NPI:1912230228
Name:EXCELLENCE PHYSICIAN BILLING
Entity Type:Organization
Organization Name:EXCELLENCE PHYSICIAN BILLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-773-0657
Mailing Address - Street 1:PO BOX 19284
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71149-0284
Mailing Address - Country:US
Mailing Address - Phone:318-773-0657
Mailing Address - Fax:318-688-0326
Practice Address - Street 1:9501 CHASE WAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-4619
Practice Address - Country:US
Practice Address - Phone:318-773-0657
Practice Address - Fax:318-688-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage