Healthcare Provider Details

I. General information

NPI: 1285387613
Provider Name (Legal Business Name): BEACON ORTHOPAEDICS & SPORTS MEDICINE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 UNIVERSITY ESTATES BLVD UNIT 100
ATHENS OH
45701-2967
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-6331
  • Fax:
Mailing address:
  • Phone: 513-354-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW THOMAS BLANKEMEYER
Title or Position: CEO
Credential:
Phone: 513-354-7785