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General NPI Number Information
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NPI Number | 1831448679
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Entity Type | Organization
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Legal Business Name | CECIL CLINIC, PLLC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 2670 NEW HOLT RD STE C
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City | PADUCAH
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State | KY
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Zip | 42001-7506
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Country | US
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Telephone | 270-575-1010
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Fax | 270-575-1018
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Provider Business Mailing Address
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Address Line | PO BOX 14252
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City | BELFAST
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State | ME
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Zip | 04915-4035
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Country | US
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Telephone | 270-575-1010
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Fax | 270-575-1018
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JOHN T CECIL JR.
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Credential | MD
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Telephone | 270-575-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA403
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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