Healthcare Provider Details

I. General information

NPI: 1164792404
Provider Name (Legal Business Name): EXCELTH, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NEWTON STREET SUITE 207
NEW ORLEANS LA
70114-2500
US

IV. Provider business mailing address

1111 NEWTON ST SUITE 207
NEW ORLEANS LA
70114-2500
US

V. Phone/Fax

Practice location:
  • Phone: 504-524-1210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATILDA A TENNESSEE
Title or Position: RCM
Credential:
Phone: 504-658-2785