Organization
EXCEL MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMIE STEELE KISER (MANAGING MEMBER)
(704) 864-0036
Entity
Organization
Contact information
Practice address
1312 HEATHERLOCH DR, GASTONIA, NC 28054-6444
(704) 864-0036
(704) 867-8367
Mailing address
1312 HEATHERLOCH DR, GASTONIA, NC 28054-6444
(704) 864-0036
(704) 867-8367
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
3515171040417
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045TR
BLUE CROSS BLUE SHIELD
NC
05
—
7704023
—
NC
Enumeration date
08/10/2006
Last updated
08/22/2020
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