Provider Demographics
NPI:1649957168
Name:BLUE ASH ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:BLUE ASH ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-530-3820
Mailing Address - Street 1:2925 VERNON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2425
Mailing Address - Country:US
Mailing Address - Phone:513-569-1355
Mailing Address - Fax:
Practice Address - Street 1:11333 CORNELL PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-1813
Practice Address - Country:US
Practice Address - Phone:513-569-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GCGA PHYSICIANS LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-28
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical