BEACON MEDICAL GROUP INC. NPI 1538265863

NPI Information

NPI: 1538265863
Provider Name: BEACON MEDICAL GROUP, INC.

Other Name: BEACON MEDICAL GROUP BEHAVIORAL HEALTH ELKHART

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1506 OSOLO RD
SUITE A
ELKHART, IN
ZIP 46514
Phone: (574) 523-3347
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BEACON MEDICAL GROUP, INC. is a mental health (including community mental health center) clinic center in Elkhart, IN. BEACON MEDICAL GROUP, INC. NPI is 1538265863. The provider is registered as an organization entity type.
The provider Other Name Is Beacon Medical Group Behavioral Health Elkhart.

The provider's business location address is:

1506 OSOLO RD
SUITE A
ELKHART, IN
ZIP 46514-122
Phone: (574) 523-3347
Fax: (574) 206-9502

The provider's authorized official is Jeffrey P Costello .
The authorized official title is Cfo and has the following contact phone number (574) 647-3549.

The enumeration date for this NPI number is 9/15/2006 and was last updated on 10/27/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	06-005017-1	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000075060	OTHER	INDIANA	ANTHEM BCBS-MSW
2	000000110756	OTHER	INDIANA	ANTHEM BCBS
3	100268350A	MEDICAID	INDIANA
4	236040	MEDICARE PIN	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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