Healthcare Provider Details

I. General information

NPI: 1164973947
Provider Name (Legal Business Name): CEP AMERICA - ILLINOIS HOSPITALISTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT ANTHONYS WAY
ALTON IL
62002-4568
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-2571
  • Fax:
Mailing address:
  • Phone: 510-851-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THEOPHILE G. KOURY
Title or Position: ADMINISTRATIVE VP OF OPERATIONS
Credential: M.D.
Phone: 510-350-2600