Healthcare Provider Details

I. General information

NPI: 1669100400
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: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 REFUGEE RD STE 180
PICKERINGTON OH
43147-9769
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
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: TIMOTHY YUCKMAN
Title or Position: CEO
Credential:
Phone: 513-354-7785