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General NPI Number Information
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NPI Number | 1841754660
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Entity Type | Organization
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Legal Business Name | CEP AMERICA - KANSAS LLC
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 3251 N ROCK RD
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City | DERBY
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State | KS
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Zip | 67037-3850
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Country | US
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Telephone | 833-345-7625
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 CUMMINS DR STE D
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City | MODESTO
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State | CA
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Zip | 95358-6411
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Country | US
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Telephone | 510-350-2600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEOPHILE G. KOURY
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Credential | MD
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Telephone | 510-350-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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