| Excelsior Healthcare Enterprises | |
|
12520 Fairwood Pkwy Bowie MD 20720-6343 | |
| (240) 486-1100 | |
| (301) 860-0765 |
| Full Name | Excelsior Healthcare Enterprises |
|---|---|
| Speciality | Internal Medicine |
| Location | 12520 Fairwood Pkwy, Bowie, Maryland |
| Authorized Official Name and Position | Wids Romeus (PRINCIPAL) |
| Authorized Official Contact | 2404861100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Excelsior Healthcare Enterprises 13103 Old Chapel Rd Bowie MD 20720-4625 Ph: (240) 486-1100 | Excelsior Healthcare Enterprises 12520 Fairwood Pkwy Bowie MD 20720-6343 Ph: (240) 486-1100 |
| NPI Number | 1225781305 |
|---|---|
| Provider Enumeration Date | 01/30/2022 |
| Last Update Date | 01/30/2022 |
| Medicare PECOS PAC ID | 7719354109 |
|---|---|
| Medicare Enrollment ID | O20221027000545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225781305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Wids Romeus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063531259 PECOS PAC ID: 3375635618 Enrollment ID: I20091210000585 |
| Provider Name | Gilma Lizaida Rivas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104472711 PECOS PAC ID: 2264864099 Enrollment ID: I20191118001125 |
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