Healthcare Provider Details

I. General information

NPI: 1114655941
Provider Name (Legal Business Name): BEACON ORTHOPAEDICS & SPORTS MEDICINE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 OLENTANGY RIVER RD
COLUMBUS OH
43212-3381
US

IV. Provider business mailing address

5040 FOREST DR STE 300
NEW ALBANY OH
43054-8166
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax: 614-523-7557
Mailing address:
  • Phone: 614-890-6555
  • Fax: 614-523-7557

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