MEDICARE: EXCELTH, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1205275492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELTH, INCORPORATED

Provider Business Mailing Address
First Line	:	1515 POYDRAS ST
Second Line	:	SUITE 1010
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-3723
Country	:	US
Telephone Number	:	504-524-1210
Fax Number	:	504-524-1491

Provider Business Practice Location Address
First Line	:	9900 LAKE FOREST BLVD
Second Line	:	SUITE F
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2609
Country	:	US
Telephone Number	:	504-524-1210
Fax Number	:	504-524-1491

Authorized Official
Title or Position	:	CFO
Name	:	MR. BYRON TREGRE
Credential	:
Telephone Number	:	504-524-1210

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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Directions to “EXCELTH, INCORPORATED ” Practice Location

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