MEDICARE: EXCELA HEALTH PHYSICIAN PRACTICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417412115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELA HEALTH PHYSICIAN PRACTICES, INC.

Provider Business Mailing Address
First Line	:	134 INDUSTRIAL PARK RD STE 1500
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-8153
Country	:	US
Telephone Number	:	724-850-6933
Fax Number	:	724-522-4002

Provider Business Practice Location Address
First Line	:	101 9TH ST
Second Line	:
City	:	SALTSBURG
State	:	PA
Zip	:	15681-8985
Country	:	US
Telephone Number	:	724-639-3541
Fax Number	:	724-639-8318

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	RENEE M VARNEY
Credential	:
Telephone Number	:	724-850-6933

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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