Provider Demographics
NPI:1205880168
Name:CEI PHYSICIANS PSC LLC
Entity type:Organization
Organization Name:CEI PHYSICIANS PSC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SN CREDENTIALS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-569-3741
Mailing Address - Street 1:4445 LAKE FOREST DR STE 600
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3744
Mailing Address - Country:US
Mailing Address - Phone:513-569-3741
Mailing Address - Fax:
Practice Address - Street 1:10615 MONTGOMERY RD STE 202
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4460
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2116436Medicaid
OH2655434Medicaid
OH2116445Medicaid
OH2116409Medicaid
OH2116392Medicaid
OH2636928Medicaid
OH2116418Medicaid
OH2116427Medicaid
OHCE9152OtherRAILROAD MEDICARE
OHCE9152OtherRAILROAD MEDICARE