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General NPI Number Information
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NPI Number | 1962257410
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Entity Type | Organization
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Legal Business Name | CEP AMERICA LLC
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 777 HOSPITAL WAY
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City | POCATELLO
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State | ID
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Zip | 83201-5175
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Country | US
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Telephone | 208-239-1000
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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 | 510-851-7501
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Fax |
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Authorized Official
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Title or Position | COO OF CLINICAL OPERATIONS
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Name | DAVID BIRDSALL
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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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