Basic Information
| Provider Information | |||||||||
| NPI: | 1063878734 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CESC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 COMMERCE ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153456900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 128 BUCKSPORT RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ELLSWORTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046052239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076676300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2016 | ||||||||
| LastUpdateDate: | 01/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | YETTER | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, BOARD OF MANAGERS | ||||||||
| AuthorizedOfficialTelephone: | 6153456900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.