Healthcare Provider Details

I. General information

NPI: 1104936624
Provider Name (Legal Business Name): BES OF OHIO, LLC, DBA MEDGROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3913 DARROW RD SUITE #100
STOW OH
44224-2621
US

IV. Provider business mailing address

PO BOX 567
CHAGRIN FALLS OH
44022-0567
US

V. Phone/Fax

Practice location:
  • Phone: 330-688-7900
  • Fax: 330-688-1866
Mailing address:
  • Phone: 216-464-5160
  • Fax: 216-464-5983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN W. ERICKSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-864-1916