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General NPI Number Information
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NPI Number | 1073609236
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Entity Type | Organization
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Legal Business Name | EXCELA HEALTH PHYSICIAN PRACTICES, INC.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 115 S 2ND ST
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City | WEST NEWTON
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State | PA
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Zip | 15089-1357
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Country | US
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Telephone | 724-872-5252
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Fax | 724-872-5501
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Provider Business Mailing Address
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Address Line | 115 S 2ND ST
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City | WEST NEWTON
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State | PA
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Zip | 15089-1357
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Country | US
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Telephone | 724-872-5252
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Fax | 724-872-5501
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Authorized Official
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Title or Position | VP, PHYS SERV & EXEC DIR, EHPP
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Name | KIRK L. MILLER
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Credential |
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Telephone | 724-830-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD041300L
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License Number State | PA
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