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NPI Code Detail

MEDICARE: PROJECT CEAP PLLC

MEDICARE: PROJECT CEAP PLLC
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
1207VC0300XComplex Family Planning Physician
2207VG0400XGynecology Physician
3363LX0001XObstetrics & Gynecology Nurse Practitioner
4207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1710745161
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROJECT CEAP PLLC
Provider Business Mailing Address
First Line : 1602 21ST ST
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-5397
Country : US
Telephone Number : 618-451-5722
Fax Number : 618-451-9092
Provider Business Practice Location Address
First Line : 1602 21ST ST
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-5397
Country : US
Telephone Number : 618-451-5722
Fax Number : 618-451-9092
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : ERIN KING
Credential : MD
Telephone Number : 618-451-5722
Provider Enumeration Date : 03/11/2024
Last Update Date : 03/11/2024

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