MEDICARE: BREWSERS ATHLETIC CLUB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		OH
2	333600000X	Pharmacy		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992702963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREWSERS ATHLETIC CLUB INC

Provider Business Mailing Address
First Line	:	849 HARMON AVE
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	OH
Zip	:	43223-2411
Country	:	US
Telephone Number	:	614-291-1677
Fax Number	:

Provider Business Practice Location Address
First Line	:	849 HARMON AVE
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	OH
Zip	:	43223-2411
Country	:	US
Telephone Number	:	614-291-1677
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN F ALTIERI
Credential	:	MBA
Telephone Number	:	614-291-1677

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/11/2025

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