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BEACON MEDICAL GROUP INC. NPI 1639196249


NPI Information

NPI: 1639196249
Provider Name: BEACON MEDICAL GROUP, INC.

Doing Business As: BEACON MEDICAL GROUP-ELKHART EAST

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 15D0714505

Address:
3301 COUNTY ROAD 6 E
ELKHART, IN
ZIP 46514
Phone: (574) 264-9635
Get Directions

BEACON MEDICAL GROUP, INC. is a family medicine in Elkhart, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BEACON MEDICAL GROUP, INC. NPI is 1639196249. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Beacon Medical Group-elkhart East.

The provider's business location address is:

3301 COUNTY ROAD 6 E
ELKHART, IN
ZIP 46514-673
Phone: (574) 264-9635
Fax: (574) 262-0398

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 CLIA number assigned to this NPI record is 15D0714505 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/17/2006 and was last updated on 4/24/2023.


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
1207Q00000XFamily Medicine06-0050171INDIANAYes

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
1100114000AMEDICAIDINDIANA
2ANTHEM BCBSOTHERINDIANA000000110759

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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