# BEACON MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Memorial Pain Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518302264
- **Authorized official:** JEFFREY P. COSTELLO (CFO)
- **Authorized official phone:** (574) 647-3549

## Contact information

- **Practice address:** 621 MEMORIAL DR, SUITE 602, SOUTH BEND, IN 46601-1063
- **Practice address phone:** (574) 647-7413
- **Practice address fax:** (574) 647-2471
- **Mailing address:** 710 N NILES AVE, SOUTH BEND, IN 46617-1924
- **Mailing address phone:** (574) 647-1610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 71001587A | IN | Yes |

## Other

- **Enumeration date:** 05/08/2013
- **Last updated:** 08/30/2016