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Phillip Albert Cetina

Internal Medicine

Allopathic & Osteopathic Physicians

200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831

PECOS Enrollment

This provider is enrolled in PECOS as PHILLIP CETINA.

Based on the most recent information from CMS, provider Phillip Albert Cetina is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1679151153
Provider Type
Individual
Full Name
Cetina, Phillip Albert
Title
Dr.
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
3/29/2021
Last Updated
7/12/2024

Contact Information

Practice Location

200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831

(502) 629-5552

Unlisted Fax

Mailing Location

550 S Jackson St Fl Street3, Louisville, KY 40202-1622

(502) 852-5666

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 05848 Kentucky
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License R6172 Kentucky

Phillip Albert Cetina

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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