| Bhg Lxvii, Llc | |
|
3910 Lima Road Obot Room 100 Fort Wayne IN 46805-1031 | |
| (260) 420-6010 | |
| (260) 420-9020 |
| Full Name | Bhg Lxvii, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3910 Lima Road, Fort Wayne, Indiana |
| Authorized Official Name and Position | Jay Higham (CEO) |
| Authorized Official Contact | 2143656112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bhg Lxvii, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244-3944 Ph: (214) 365-6100 | Bhg Lxvii, Llc 3910 Lima Road Obot Room 100 Fort Wayne IN 46805-1031 Ph: (260) 420-6010 |
| NPI Number | 1275316697 |
|---|---|
| Provider Enumeration Date | 08/17/2023 |
| Last Update Date | 08/17/2023 |
| Certification Date | 08/17/2023 |
| Medicare PECOS PAC ID | 3971959628 |
|---|---|
| Medicare Enrollment ID | O20231101000502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275316697 | NPI | - | NPPES |
| Provider Name | Matthew A Byers |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124314398 PECOS PAC ID: 5294025185 Enrollment ID: I20160606001204 |
| Provider Name | Faryal Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811557556 PECOS PAC ID: 6507193315 Enrollment ID: I20231211000724 |
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