Provider Demographics
NPI:1699496265
Name:EXCELSIOR TESTING LLC
Entity type:Organization
Organization Name:EXCELSIOR TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:803-735-6306
Mailing Address - Street 1:538 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6868
Mailing Address - Country:US
Mailing Address - Phone:803-735-6306
Mailing Address - Fax:
Practice Address - Street 1:652 BUSH RIVER RD STE 217
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7537
Practice Address - Country:US
Practice Address - Phone:803-735-6306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty