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General NPI Number Information
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NPI Number | 1629388319
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Entity Type | Organization
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Legal Business Name | EXCELLENCE MEDICAL CENTERS,LLC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 4304 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-7169
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Country | US
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Telephone | 239-540-0800
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Fax | 239-540-0806
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Provider Business Mailing Address
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Address Line | 4304 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-7169
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Country | US
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Telephone | 239-540-0800
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Fax | 239-540-0806
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE MACKIE
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Credential | M.D.
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Telephone | 239-540-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME94225
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License Number State | FL
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