Provider Demographics
NPI:1366559130
Name:EXCEL ANESTHESIA, LLC
Entity type:Organization
Organization Name:EXCEL ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COVILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:913-721-3641
Mailing Address - Street 1:1701 S 45TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-2527
Mailing Address - Country:US
Mailing Address - Phone:913-721-3641
Mailing Address - Fax:913-721-3649
Practice Address - Street 1:1701 S 45TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-2527
Practice Address - Country:US
Practice Address - Phone:913-721-3641
Practice Address - Fax:913-721-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS180055OtherBLUE CROSS BLUE SHIELD KANSAS
KS200418810AMedicaid
MO502853203Medicaid
MODF4368OtherRR MEDICARE
KSDF1966OtherRR MEDICARE
MO10811031OtherBLUE CROSS BLUE SHIELD KANSAS CITY
KS180055OtherBLUE CROSS BLUE SHIELD KANSAS
MOMA1170Medicare PIN
KSW490000BMedicare PIN
MOW490000AMedicare PIN
KSDF1966OtherRR MEDICARE