1033108592 NPI number — CEI PHYSICIANS PSC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033108592 NPI number — CEI PHYSICIANS PSC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEI PHYSICIANS PSC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033108592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 CEI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-5664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-569-3741
Provider Business Mailing Address Fax Number:
513-569-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 S LOOP RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-9000
Provider Business Practice Location Address Fax Number:
859-331-9040
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
TERI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CORPORATE CREDENTIALS MANAGER
Authorized Official Telephone Number:
513-569-3741

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6592833500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100004440D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2215721 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC6633 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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