=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417388539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCEL HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2013
-----------------------------------------------------
Last Update Date | 08/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3121 N REYNOLDS RD SUITE 4
-----------------------------------------------------
City | BRYANT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72022-9191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-847-3292
-----------------------------------------------------
Fax | 501-213-0573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3121 N REYNOLDS RD SUITE 4
-----------------------------------------------------
City | BRYANT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72022-9191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-847-3292
-----------------------------------------------------
Fax | 501-213-0573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAY COOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-847-3292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | E4676
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------