MEDICARE: BEACON HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0200X	Radiology Clinic/Center
3	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952982217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON HEALTH, LLC

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-1069
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 RIETH BLVD STE 101
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-5869
Country	:	US
Telephone Number	:	574-875-1082
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JEFFREY P COSTELLO
Credential	:
Telephone Number	:	574-647-3460

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/28/2023

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Directions to “BEACON HEALTH, LLC ” Practice Location

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