Provider Demographics
NPI:1861656449
Name:BEACON ORTHOPAEDICS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BEACON ORTHOPAEDICS SURGERY CENTER, LLC
Other - Org Name:BEACON WEST SURGICAL 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:513-530-3062
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:513-354-7785
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:6480 HARRISON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7961
Practice Address - Country:US
Practice Address - Phone:513-354-7750
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:2008-07-14
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0819AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE3612231Medicare PIN