Provider Demographics
NPI:1407334881
Name:BEACON ORTHOPAEDIC SURGERY CENTER
Entity Type:Organization
Organization Name:BEACON ORTHOPAEDIC SURGERY CENTER
Other - Org Name:BEACON AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BLANKEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:513-354-7603
Mailing Address - Street 1:501 E BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2365
Mailing Address - Country:US
Mailing Address - Phone:513-354-3737
Mailing Address - Fax:513-354-3708
Practice Address - Street 1:501 E BUSINESS WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2365
Practice Address - Country:US
Practice Address - Phone:513-354-3737
Practice Address - Fax:513-354-3708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACON ORTHOPAEDICS & SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0711AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical