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Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Maternal Fetal Medicine South Bend
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
100 NAVARRE PL STE 4410, SOUTH BEND, IN 46601-1171
(574) 647-6370
(574) 647-6373
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
Primary
01053966A
IN
2086S0102X
Surgical Critical Care Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300114652
—
IN
05
—
300125576
—
IN
Enumeration date
05/17/2006
Last updated
02/10/2026
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