Healthcare Provider Details

I. General information

NPI: 1093007213
Provider Name (Legal Business Name): CEP AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PLEASANT VALLEY ROAD
OWENSBORO KY
42303-9619
US

IV. Provider business mailing address

2100 POWELL ST STE 920
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 270-417-2000
  • Fax:
Mailing address:
  • Phone: 510-350-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THEOPHILE KOURY
Title or Position: COO
Credential: MD
Phone: 510-350-2600