NPIMap

Organization Active NPI

Excel Medical Clinic, Inc.

  • Primary Care Clinic/Center
  • Woodbridge, VA
National Provider Identifier
1164858205
Registry record updated Sep 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
0024166397 Issued in VA
Legal business name
EXCEL MEDICAL CLINIC, INC.
Practice address
14904 Jefferson Davis Hwy
Suite 205
Woodbridge, VA 22191-3908
Phone
(703) 497-4500
Fax
(703) 494-4671
NPI assigned
Sep 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shriharsh Laxman Pole
Title
President
Phone
(703) 497-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 0024166397 VA Primary

Addresses

Primary practice location

14904 Jefferson Davis Hwy
Suite 205
Woodbridge, VA 22191-3908

Mailing address

14904 Jefferson Davis Hwy
Suite 205
Woodbridge, VA 22191-3908
Phone (703) 497-4500

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379635200000",
    "number": "1164858205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14904 JEFFERSON DAVIS HWY",
            "address_2": "SUITE 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913908",
            "telephone_number": "703-497-4500",
            "fax_number": "703-494-4671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14904 JEFFERSON DAVIS HWY",
            "address_2": "SUITE 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913908",
            "telephone_number": "703-497-4500",
            "fax_number": "703-494-4671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-20",
        "last_updated": "2013-09-20",
        "status": "A",
        "authorized_official_last_name": "POLE",
        "authorized_official_first_name": "SHRIHARSH",
        "authorized_official_middle_name": "LAXMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-497-4500"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "0024166397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.