Healthcare Provider Details

I. General information

NPI: 1275693798
Provider Name (Legal Business Name): BES OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W MARKET ST
FAIRLAWN OH
44333-4202
US

IV. Provider business mailing address

2640 W MARKET ST
FAIRLAWN OH
44333-4202
US

V. Phone/Fax

Practice location:
  • Phone: 330-864-1916
  • Fax: 330-864-1924
Mailing address:
  • Phone: 330-864-1916
  • Fax: 330-864-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN ERICKSON
Title or Position: PARTNER
Credential: MD
Phone: 330-864-1916