Healthcare Provider Details

I. General information

NPI: 1073609236
Provider Name (Legal Business Name): EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S 2ND ST
WEST NEWTON PA
15089-1357
US

IV. Provider business mailing address

115 S 2ND ST
WEST NEWTON PA
15089-1357
US

V. Phone/Fax

Practice location:
  • Phone: 724-872-5252
  • Fax: 724-872-5501
Mailing address:
  • Phone: 724-872-5252
  • Fax: 724-872-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD041300L
License Number StatePA

VIII. Authorized Official

Name: KIRK L. MILLER
Title or Position: VP, PHYS SERV & EXEC DIR, EHPP
Credential:
Phone: 724-830-8500