Healthcare Provider Details

I. General information

NPI: 1831448679
Provider Name (Legal Business Name): CECIL CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 NEW HOLT RD STE C
PADUCAH KY
42001-7506
US

IV. Provider business mailing address

PO BOX 14252
BELFAST ME
04915-4035
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-1010
  • Fax: 270-575-1018
Mailing address:
  • Phone: 270-575-1010
  • Fax: 270-575-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA403
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN T CECIL JR.
Title or Position: SOLE MEMBER
Credential: MD
Phone: 270-575-1010