Provider Demographics
NPI:1164715371
Name:BEACON HEALTH LLC
Entity Type:Organization
Organization Name:BEACON HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARSHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-525-7953
Mailing Address - Street 1:8000 IH 10 W
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3802
Mailing Address - Country:US
Mailing Address - Phone:210-525-7953
Mailing Address - Fax:
Practice Address - Street 1:8000 IH 10 W
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3802
Practice Address - Country:US
Practice Address - Phone:210-525-7953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty