=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316744188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELA HEALTH PHYSICIAN PRACTICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 S WASHINGTON AVE
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-689-1331
-----------------------------------------------------
Fax | 724-689-0548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 S WASHINGTON AVE
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-689-1331
-----------------------------------------------------
Fax | 724-689-0548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CRED COORD
-----------------------------------------------------
Name | RENEE M VARNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-454-6099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------