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General NPI Number Information
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NPI Number | 1982224259
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Entity Type | Organization
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Legal Business Name | EXCALIBUR TELEMEDICAL SERVICES
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 405 WATERFORD LN
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City | GULF BREEZE
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State | FL
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Zip | 32561-4872
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Country | US
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Telephone | 850-982-9384
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Fax | 850-934-0711
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Provider Business Mailing Address
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Address Line | 405 WATERFORD LN
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City | GULF BREEZE
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State | FL
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Zip | 32561-4872
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Country | US
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Telephone | 850-982-9384
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Fax | 850-934-0711
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. KIM LANDRY
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Credential | MD
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Telephone | 850-982-9384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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