Healthcare Provider Details

I. General information

NPI: 1285045922
Provider Name (Legal Business Name): BECKETT SPRINGS PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 SHEPHERD FARM DR
WEST CHESTER OH
45069-1128
US

IV. Provider business mailing address

8614 SHEPHERD FARM DR
WEST CHESTER OH
45069-1128
US

V. Phone/Fax

Practice location:
  • Phone: 513-942-9500
  • Fax: 513-714-7374
Mailing address:
  • Phone: 513-942-9500
  • Fax: 513-714-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GINA WARREN
Title or Position: DIRECTOR CREDENTIALING & PAYOR ENRO
Credential:
Phone: 502-400-8480