MEDICARE: CEI PHYSICIANS PSC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1891406328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEI PHYSICIANS PSC, LLC

Provider Business Mailing Address
First Line	:	5106 WILSON MILLS RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-3006
Country	:	US
Telephone Number	:	440-461-2570
Fax Number	:	440-461-7109

Provider Business Practice Location Address
First Line	:	5106 WILSON MILLS RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-3006
Country	:	US
Telephone Number	:	440-461-2570
Fax Number	:	440-461-7109

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SUPERVISOR
Name	:	MONICA COOPER
Credential	:
Telephone Number	:	636-200-4393

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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