Healthcare Provider Details

I. General information

NPI: 1013365311
Provider Name (Legal Business Name): CEP AMERICA - ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2104
US

IV. Provider business mailing address

PO BOX 45741
SAN FRANCISCO CA
94145-0741
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7000
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: THEOPHILE KOURY
Title or Position: AUTHORIZED OFFICAL
Credential: MD
Phone: 800-516-5315