Healthcare Provider Details

I. General information

NPI: 1710745161
Provider Name (Legal Business Name): PROJECT CEAP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 21ST ST
GRANITE CITY IL
62040-5397
US

IV. Provider business mailing address

1602 21ST ST
GRANITE CITY IL
62040-5397
US

V. Phone/Fax

Practice location:
  • Phone: 618-451-5722
  • Fax: 618-451-9092
Mailing address:
  • Phone: 618-451-5722
  • Fax: 618-451-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIN KING
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 618-451-5722