Healthcare Provider Details

I. General information

NPI: 1205275492
Provider Name (Legal Business Name): EXCELTH, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LAKE FOREST BLVD SUITE F
NEW ORLEANS LA
70127-2609
US

IV. Provider business mailing address

1515 POYDRAS ST SUITE 1010
NEW ORLEANS LA
70112-3723
US

V. Phone/Fax

Practice location:
  • Phone: 504-524-1210
  • Fax: 504-524-1491
Mailing address:
  • Phone: 504-524-1210
  • Fax: 504-524-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BYRON TREGRE
Title or Position: CFO
Credential:
Phone: 504-524-1210