MEDICARE: CEP AMERICA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1093007213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEP AMERICA LLC

Provider Business Mailing Address
First Line	:	2100 POWELL ST
Second Line	:	STE 920
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1826
Country	:	US
Telephone Number	:	510-350-2698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 PLEASANT VALLEY ROAD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-9619
Country	:	US
Telephone Number	:	270-417-2000
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	THEOPHILE KOURY
Credential	:	MD
Telephone Number	:	510-350-2600

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	08/02/2013

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Directions to “CEP AMERICA LLC ” Practice Location

Language	Start Address	Practice Location

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