Provider Demographics
NPI:1346988870
Name:E-ASC LLC
Entity Type:Organization
Organization Name:E-ASC LLC
Other - Org Name:BEACON EVENDALE SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MGR OF CONTRACTING AND CREDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-354-3700
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-7662
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:3155 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3134
Practice Address - Country:US
Practice Address - Phone:513-454-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0011436Medicaid
OH1305ASOtherSTATE LICENSE