MEDICARE: EXCEL CARE OB GYN 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1457321846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL CARE OB GYN INC

Provider Business Mailing Address
First Line	:	1439 US HWY 61
Second Line	:	SUITE A
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019
Country	:	US
Telephone Number	:	636-937-6484
Fax Number	:	636-933-0277

Provider Business Practice Location Address
First Line	:	1439 US HWY 61
Second Line	:	SUITE A
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019
Country	:	US
Telephone Number	:	636-937-6484
Fax Number	:	636-933-0277

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CATHY D LEFARTH
Credential	:
Telephone Number	:	636-937-6484

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/22/2020

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