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General NPI Number Information
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NPI Number | 1265160097
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Entity Type | Organization
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Legal Business Name | BEACON ORTHOPAEDICS & SPORTS MEDICINE LTD
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1325 STRINGTOWN RD STE 280
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City | GROVE CITY
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State | OH
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Zip | 43123-7201
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Country | US
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Telephone | 614-890-6555
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Fax | 614-523-7557
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Provider Business Mailing Address
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Address Line | 6480 HARRISON AVE STE 201
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City | CINCINNATI
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State | OH
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Zip | 45247-7961
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Country | US
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Telephone | 614-890-6555
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Fax | 614-523-7557
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Authorized Official
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Title or Position | CEO
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Name | TIMOTHY YUCKMAN
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Credential |
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Telephone | 513-354-7785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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