Healthcare Provider Details

I. General information

NPI: 1639678790
Provider Name (Legal Business Name): CEP AMERICA-ILLINOIS HOSPITALISTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 HOLY CROSS LN
BREESE IL
62230-3618
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-4511
  • Fax:
Mailing address:
  • Phone: 510-350-2680
  • Fax: 510-879-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BIRDSALL
Title or Position: ADMINISTRATIVE VP OF OPERATIONS
Credential: MD
Phone: 510-350-2600