Healthcare Provider Details

I. General information

NPI: 1366559130
Provider Name (Legal Business Name): EXCEL ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S 45TH ST SUITE A
KANSAS CITY KS
66106-2527
US

IV. Provider business mailing address

1701 S 45TH ST SUITE A
KANSAS CITY KS
66106-2527
US

V. Phone/Fax

Practice location:
  • Phone: 913-721-3641
  • Fax: 913-721-3649
Mailing address:
  • Phone: 913-721-3641
  • Fax: 913-721-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. JEAN MARIE COVILLO
Title or Position: MANAGING MEMBER
Credential: CRNA
Phone: 913-721-3641