Healthcare Provider Details

I. General information

NPI: 1124331277
Provider Name (Legal Business Name): EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8775 NORWIN AVE
NORTH HUNTINGDON PA
15642-2718
US

IV. Provider business mailing address

134 INDUSTRIAL PARK RD STE 1500
GREENSBURG PA
15601-8153
US

V. Phone/Fax

Practice location:
  • Phone: 855-765-7277
  • Fax: 724-863-0046
Mailing address:
  • Phone: 724-850-6933
  • Fax: 724-522-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE M VARNEY
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 724-850-6933