MEDICARE: BLUE ASH ENDOSCOPY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1649957168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE ASH ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	2925 VERNON PL STE 100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2425
Country	:	US
Telephone Number	:	513-569-1355
Fax Number	:

Provider Business Practice Location Address
First Line	:	11333 CORNELL PARK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-1813
Country	:	US
Telephone Number	:	513-569-1355
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	LAWRENCE FRENI
Credential	:
Telephone Number	:	786-530-3820

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	01/09/2025

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