Provider Demographics
NPI:1972214682
Name:CEI PHYSICIANS PSC, LLC
Entity Type:Organization
Organization Name:CEI PHYSICIANS PSC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-200-4393
Mailing Address - Street 1:518 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2117
Mailing Address - Country:US
Mailing Address - Phone:330-630-9699
Mailing Address - Fax:330-633-7165
Practice Address - Street 1:518 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2117
Practice Address - Country:US
Practice Address - Phone:330-630-9699
Practice Address - Fax:330-633-7165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEI PHYSICIANS PSC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical