1306183546 NPI number — EXCEL PSYCHIATRIC ASSOCIATES, PA

Table of content: (NPI 1306183546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306183546 NPI number — EXCEL PSYCHIATRIC ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL PSYCHIATRIC ASSOCIATES, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306183546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10225 HICKORYWOOD HILL AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-457-9292
Provider Business Mailing Address Fax Number:
704-274-5783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10225 HICKORYWOOD HILL AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-457-9292
Provider Business Practice Location Address Fax Number:
704-274-5783
Provider Enumeration Date:
01/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHEPKE
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
704-457-9292

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C007832 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 2009-00088 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5912334 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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