Organization · NPI-2

Bhg Lxvii, LLC

Clinic/Center, Multi-Specialty · Fort Wayne, IN

NPI number1275316697

StatusActive

Last updated in NPPESSep 22, 2025

Details

NPI: 1275316697
Entity type: Organization (NPI-2)
Legal business name: Bhg Lxvii, LLC
Organization subpart: No
Enumeration date: Aug 17, 2023
Certification date: Sep 22, 2025
Last updated: Sep 22, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QM1300X	Clinic/Center, Multi-Specialty	–	–	Yes
103TA0400X	Psychologist, Addiction (Substance Use Disorder)	–	–
2084A0401X	Psychiatry & Neurology, Addiction Medicine	–	–
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
207QA0401X	Family Medicine, Addiction Medicine	–	–
2083A0300X	Preventive Medicine, Addiction Medicine	–	–
363L00000X	Nurse Practitioner	–	–
363LP0808X	Nurse Practitioner, Psych/Mental Health	–	–
207RA0401X	Internal Medicine, Addiction Medicine	–	–

Other names

Bhg Medical Services - Indiana (Doing Business As)

Practice location

3910 Lima Road
Obot Room 100
Fort Wayne, IN 46805-1031

Phone 260-420-6010 · Fax 260-420-9020

Mailing address

5001 Spring Valley Rd Ste 600
Dallas, TX 75244-3946

Phone 214-365-6100 · Fax 214-365-6150

Authorized official

Anthony Kilgore
Ceo
2143656112

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