Provider Demographics
NPI:1033359948
Name:BES OF OHIO, LLC DBA MEDGROUP
Entity Type:Organization
Organization Name:BES OF OHIO, LLC DBA MEDGROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-688-7900
Mailing Address - Street 1:3913 DARROW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2621
Mailing Address - Country:US
Mailing Address - Phone:330-688-7900
Mailing Address - Fax:330-688-1866
Practice Address - Street 1:3913 DARROW RD STE 100
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2621
Practice Address - Country:US
Practice Address - Phone:330-688-7900
Practice Address - Fax:330-688-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1311180002Medicare NSC