# BEACON MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BEACON HEALTH SYSTEM, INC.
- **Other names:** Beacon Medical Group Midwifery Centered Care South Bend
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1578862181
- **Legal business name:** BEACON HEALTH SYSTEM, INC.
- **Authorized official:** JEFFREY P COSTELLO (VP/CFO)
- **Authorized official phone:** (574) 647-3549

## Contact information

- **Practice address:** 100 NAVARRE PL STE 4470, SOUTH BEND, IN 46601-1168
- **Practice address phone:** (574) 647-1405
- **Practice address fax:** (574) 647-3970
- **Mailing address:** 3245 HEALTH DR STE 100, GRANGER, IN 46530-1380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 367A00000X | Advanced Practice Midwife | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2011
- **Last updated:** 01/30/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201020740A | — | IN |