Cep America- Illinois SNF, LLP
Organization Active NPI Internal Medicine Physician · Breese, IL
NPI 1154801744 · NPPES record last updated Mar 30, 2020
Key facts
- NPI
- 1154801744
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CEP AMERICA- ILLINOIS SNF, LLP
- Practice address
- 1155 N 1St St
Breese, IL 62230-1735 - Phone
- (618) 526-4521
- NPI assigned
- Aug 14, 2018
- Organization subpart
- No
Authorized official
- Name
- Theophile G. Koury, MD
- Title
- Administrative VP of Operations
- Phone
- (510) 350-2600
Other NPIs on the same Medicare enrollment 17
Corporate family (same tax ID) 9
Practitioners 1
-
Lavada Jean Smith, ANP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161012002933 | IL | Part B Supplier - Clinic/Group Practice | 8022306737 |
Receives reassigned benefits from 53 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cahokia, IL; Shiloh, IL; Godfrey, IL; Edwardsville, IL; Caseyville, IL; Breese, IL; Belleville, IL; Alton, IL |
National Provider Directory
- Tax ID family
- Cep America - Illinois SNF LLP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1155 N 1St St
Breese, IL 62230-1735
Mailing address
1601 Cummins Dr Ste D
Modesto, CA 95358-6411
Phone (510) 350-2600
Other providers in Breese, IL
- Kristina G Buehne
- Jessica Lynn Campbell
- Caring First Inc.
- Central Comm HS Dist 71
- Cep America Illinois Intensivists
- Cep America-Illinois Hospitalists, LLP
- Cepamerica Illinois LLP
- City of Breese
- Clarkson Optometry Illinois PC
- Clinton M. Smith DC PC
All providers in Breese, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.