Healthcare Provider Details

I. General information

NPI: 1639788250
Provider Name (Legal Business Name): CEP AMERICA - NEUROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MAIN ST
CLINTON IN
47842-2261
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 765-832-1234
  • Fax:
Mailing address:
  • Phone: 510-350-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BIRDSALL
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 510-350-2680