Basic Information
| Provider Information | |||||||||
| NPI: | 1538539820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCELA HEALTH PHYSICIAN PRACTICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 93 | ||||||||
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| City: | LANDISVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175380093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008001617 | ||||||||
| FaxNumber: | 8667595426 | ||||||||
| Practice Location | |||||||||
| Address1: | 532 W PITTSBURGH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248324000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | DISHONG | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT/EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7248308500 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EXCELA HEALTH HOLDING COMPANY INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.