MEDICARE: CEB CAPITAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1073986212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEB CAPITAL LLC

Provider Business Mailing Address
First Line	:	9150 W INDIAN SCHOOL RD
Second Line	:	SUITE 111B
City	:	PHOENIX
State	:	AZ
Zip	:	85037-2384
Country	:	US
Telephone Number	:	623-247-2300
Fax Number	:	623-247-1939

Provider Business Practice Location Address
First Line	:	4502 W INDIAN SCHOOL RD
Second Line	:	SUITE A-3
City	:	PHOENIX
State	:	AZ
Zip	:	85031-2800
Country	:	US
Telephone Number	:	623-247-0414
Fax Number	:	623-247-0424

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	IVY JONES
Credential	:
Telephone Number	:	623-247-2300

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	03/23/2016

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Directions to “CEB CAPITAL LLC ” Practice Location

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