| Beacon Medical Group Wakarusa | |
|
207 N Elkhart St Wakarusa IN 46573-9729 | |
| (574) 862-2165 | |
| (574) 862-4112 |
| Full Name | Beacon Medical Group Wakarusa |
|---|---|
| Speciality | Family Medicine |
| Location | 207 N Elkhart St, Wakarusa, 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 Wakarusa 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Wakarusa 207 N Elkhart St Wakarusa IN 46573-9729 Ph: (574) 862-2165 |
| NPI Number | 1184641706 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 03/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184641706 | NPI | - | NPPES |
| ANTHEM BCBS | Other | IN | 000000110760 |
| 200019030A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Wanee Walk In Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1028 E Waterford St, Suite A, Wakarusa, IN 46573 Phone: 574-523-3227 Fax: 574-296-6522 | |
Heritage Family Medicine, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 111 N Elkhart St, Wakarusa, IN 46573 Phone: 574-900-1991 Fax: 574-900-1193 |