Organization
BEACON HEALTH, LLC
Active
Other names
Beacon Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P COSTELLO (CFO)
(574) 647-3460
Entity
Organization
Contact information
Practice address
2222 RIETH BLVD STE 101, GOSHEN, IN 46526-5869
(574) 875-1082
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1069
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300068141
—
IN
Enumeration date
04/19/2021
Last updated
04/28/2023
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