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Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Parent organization
BEACON HEALTH SYSTEM, INC.
Other names
Beacon Medical Group Midwifery Centered Care South Bend
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEACON HEALTH SYSTEM, INC.
Authorized official
JEFFREY P COSTELLO (VP/CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
100 NAVARRE PL STE 4470, SOUTH BEND, IN 46601-1168
(574) 647-1405
(574) 647-3970
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
363LW0102X
Women's Health Nurse Practitioner
—
NULL
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
Primary
—
NULL
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201020740A
—
IN
Enumeration date
03/22/2011
Last updated
01/30/2025
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