Provider Demographics
NPI:1235867409
Name:BEACON ORTHOPAEDICS & SPORTS MEDICINE LTD
Entity type:Organization
Organization Name:BEACON ORTHOPAEDICS & SPORTS MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BLANKEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-354-7785
Mailing Address - Street 1:5040 FOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8166
Mailing Address - Country:US
Mailing Address - Phone:614-890-6555
Mailing Address - Fax:614-523-7557
Practice Address - Street 1:5040 FOREST DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8167
Practice Address - Country:US
Practice Address - Phone:614-890-6555
Practice Address - Fax:614-523-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty