Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Behavioral Health Elkhart
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
1506 OSOLO RD, SUITE A, ELKHART, IN 46514-4122
(574) 523-3347
(574) 206-9502
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
06-005017-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000075060
ANTHEM BCBS-MSW
IN
01
—
000000110756
ANTHEM BCBS
IN
05
—
100268350A
—
IN
Enumeration date
09/15/2006
Last updated
10/27/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us