Healthcare Provider Details

I. General information

NPI: 1649957168
Provider Name (Legal Business Name): BLUE ASH ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 CORNELL PARK DR
CINCINNATI OH
45242-1813
US

IV. Provider business mailing address

2925 VERNON PL STE 100
CINCINNATI OH
45219-2425
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-1355
  • Fax:
Mailing address:
  • Phone: 513-569-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE FRENI
Title or Position: CFO
Credential:
Phone: 786-530-3820