Beacon Medical Group, Inc., NPI 1538265863
Mental Health Clinic/Center (Including Community Mental Health Center) in Elkhart, IN, US
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 |
Organization Official
| Official Name | MR. Jeffrey P Costello |
| Official Position | CFO |
| Phone | 574-647-3549 |
Primary Taxonomy
| Taxonomy Code | |
| Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center) |
| Classification | |
| Group | |
| License No. | 06-005017-1 |
| License State | IN |
| Description | Definition to come... |
Other Identifiers
| Identifier | Identifier State | Identifier Issuer | Type/Code |
|---|---|---|---|
| 000000110756 | IN | ANTHEM BCBS | 01 |
| 000000075060 | IN | ANTHEM BCBS-MSW | 01 |
| 100268350A | IN | MEDICAID | 05 |
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