Organization
EXCELSIA MO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WALL (CHIEF LEGAL OFFICER)
(412) 496-5959
Entity
Organization
Contact information
Practice address
4434 S LINDBERGH BLVD, SAINT LOUIS, MO 63127-1647
(410) 933-5678
Mailing address
9601 PULASKI PARK DR STE 417, MIDDLE RIVER, MD 21220-1409
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/04/2023
Last updated
01/24/2024
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