Provider Demographics
NPI:1023589058
Name:BEACON ORTHOPAEDICS & SPORTS MEDICINE, LTD
Entity type:Organization
Organization Name:BEACON ORTHOPAEDICS & SPORTS MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BLANKEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-530-3062
Mailing Address - Street 1:500 E BUSINESS WAY STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2374
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:
Practice Address - Street 1:500 E BUSINESS WAY STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2374
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000020238OtherANTHEM
OH2374818Medicaid