Beacon Medical Group, Inc., NPI 1538265863
Mental Health Clinic/Center (Including Community Mental Health Center) in Elkhart, IN, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1538265863
NPI Entity Type Organization
Provider Name Beacon Medical Group, Inc.
Other Name
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Provider Location Address 1506 Osolo Rd, Suite A, Elkhart, IN, US
Provider Mailing Address 710 N Niles Ave, South Bend, IN, US, 466171924
Is Sole Proprietor? No
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Organization Official

Official Name MR. Jeffrey P Costello
Official Position CFO
Phone 574-647-3549

Primary Taxonomy

Taxonomy Code

261QM0801X

Taxonomy Name Mental Health Clinic/Center (Including Community Mental Health Center)
Classification

Clinic/Center

Group

Ambulatory Health Care Facilities

License No. 06-005017-1
License State IN
Description Definition to come...

Other Organization Name

Beacon Medical Group Behavioral Health Elkhart
Other Name

Business Address

Beacon Medical Group, Inc.
1506 Osolo Rd
Suite A

Elkhart, IN, US

Phone: 574-523-3347
Fax: 574-206-9502

Mailing Address

Beacon Medical Group, Inc.
710 N Niles Ave
South Bend, IN, US
ZIP 466171924
Phone: 574-647-1610
Fax: 574-237-6069

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
000000110756 IN ANTHEM BCBS 01
000000075060 IN ANTHEM BCBS-MSW 01
100268350A IN MEDICAID 05

Other Providers in IN, US

NPI Name Taxonomy Address

1528516226

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FNP-C Colleen Conwell

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MD Julie A Tillman

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DR. M.D. Rebecca E Minser

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DR. M.D. Dona M Uncheselu

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MD Kevin K Hart

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MD Megan C. Lemon

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Kelcie Marie Small

Individual

Developmental Therapist

6437 Rucker Rd Ste D

Indianapolis, IN

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