| Beacon Medical Group-elkhart East | |
|
3301 County Road 6 E Elkhart IN 46514-7673 | |
| (574) 264-9635 | |
| (574) 262-0398 |
| Full Name | Beacon Medical Group-elkhart East |
|---|---|
| Speciality | Family Medicine |
| Location | 3301 County Road 6 E, 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-elkhart East 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group-elkhart East 3301 County Road 6 E Elkhart IN 46514-7673 Ph: (574) 264-9635 |
| NPI Number | 1639196249 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 04/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639196249 | NPI | - | NPPES |
| 100114000A | Medicaid | IN | |
| ANTHEM BCBS | Other | IN | 000000110759 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 06-0050171 (Indiana) | Primary |
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