Organization
BEACON HEALTH VENTURES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY M CONRAD (PRESIDENT)
(574) 647-8777
Entity
Organization
Contact information
Practice address
2602 SOUTH U.S. 35, KNOX, IN 46534
(574) 772-4458
Mailing address
3355 DOUGLAS ROAD, SOUTH BEND, IN 46635-1780
(574) 273-2273
(574) 273-5602
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
69000136A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097412
ANTHEM PROVIDER
IN
05
—
200253800B
—
IN
Enumeration date
11/13/2006
Last updated
02/27/2017
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