Provider Demographics
NPI:1073986212
Name:CEB CAPITAL LLC
Entity Type:Organization
Organization Name:CEB CAPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-247-2300
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 111B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2384
Mailing Address - Country:US
Mailing Address - Phone:623-247-2300
Mailing Address - Fax:623-247-1939
Practice Address - Street 1:4502 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE A-3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2800
Practice Address - Country:US
Practice Address - Phone:623-247-0414
Practice Address - Fax:623-247-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty