Provider Demographics
NPI:1942968524
Name:BEACON HEALTH LLC
Entity Type:Organization
Organization Name:BEACON HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:239-799-7057
Mailing Address - Street 1:1656 MEDICAL BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1423
Mailing Address - Country:US
Mailing Address - Phone:239-799-7057
Mailing Address - Fax:239-799-2131
Practice Address - Street 1:1656 MEDICAL BLVD STE 301
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1423
Practice Address - Country:US
Practice Address - Phone:239-593-6204
Practice Address - Fax:239-799-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty