MEDICARE: CECIL CLINIC, 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
1	363LF0000X	Family Nurse Practitioner
2	363A00000X	Physician Assistant	PA403	KY
3	2080P0006X	Developmental - Behavioral Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831448679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CECIL CLINIC, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 14252
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4035
Country	:	US
Telephone Number	:	270-575-1010
Fax Number	:	270-575-1018

Provider Business Practice Location Address
First Line	:	2670 NEW HOLT RD STE C
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-7506
Country	:	US
Telephone Number	:	270-575-1010
Fax Number	:	270-575-1018

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. JOHN T CECIL JR.
Credential	:	MD
Telephone Number	:	270-575-1010

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	12/20/2016

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Directions to “CECIL CLINIC, PLLC ” Practice Location

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