Healthcare Provider Details

I. General information

NPI: 1891406328
Provider Name (Legal Business Name): CEI PHYSICIANS PSC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 WILSON MILLS RD
RICHMOND HEIGHTS OH
44143-3006
US

IV. Provider business mailing address

5106 WILSON MILLS RD
RICHMOND HEIGHTS OH
44143-3006
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-2570
  • Fax: 440-461-7109
Mailing address:
  • Phone: 440-461-2570
  • Fax: 440-461-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONICA COOPER
Title or Position: PROVIDER ENROLLMENT SUPERVISOR
Credential:
Phone: 636-200-4393