| Beacon Medical Group Behavioral Health Elkhart | |
|
1506 Osolo Rd Suite A Elkhart IN 46514-4122 | |
| (574) 523-3347 | |
| (574) 206-9502 |
| Full Name | Beacon Medical Group Behavioral Health Elkhart |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1506 Osolo Rd, Elkhart, Indiana |
| Authorized Official Name and Position | Jeffrey P Costello (CFO) |
| Authorized Official Contact | 5746473549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Medical Group Behavioral Health Elkhart 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Behavioral Health Elkhart 1506 Osolo Rd Suite A Elkhart IN 46514-4122 Ph: (574) 523-3347 |
| NPI Number | 1538265863 |
|---|---|
| Provider Enumeration Date | 09/15/2006 |
| Last Update Date | 10/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538265863 | NPI | - | NPPES |
| 000000110756 | Other | IN | ANTHEM BCBS |
| 000000075060 | Other | IN | ANTHEM BCBS-MSW |
| 100268350A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 06-005017-1 (Indiana) | Primary |
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