Provider Demographics
NPI:1609242643
Name:JEFFREY BEVAN, LLC
Entity Type:Organization
Organization Name:JEFFREY BEVAN, LLC
Other - Org Name:SENTINEL HEALTH OF OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN, FNP-BC
Authorized Official - Phone:888-850-1830
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0915
Mailing Address - Country:US
Mailing Address - Phone:888-850-1830
Mailing Address - Fax:740-201-1099
Practice Address - Street 1:4449 EASTON WAY FL 2
Practice Address - Street 2:PMB 20094
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7005
Practice Address - Country:US
Practice Address - Phone:888-850-1830
Practice Address - Fax:740-201-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care