# BEACON MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beacon Medical Group Cardio Thoracic Surgery Elkhart
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841582087
- **Authorized official:** MR. JEFF P COSTELLO (CFO)
- **Authorized official phone:** (574) 647-3549

## Contact information

- **Practice address:** 500 ARCADE AVE STE 230, ELKHART, IN 46514-2485
- **Practice address phone:** (574) 522-6565
- **Practice address fax:** (574) 522-5572
- **Mailing address:** 710 N NILES AVE, SOUTH BEND, IN 46617-1924
- **Mailing address phone:** (574) 647-1610
- **Mailing address fax:** (574) 237-6069

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/06/2011
- **Last updated:** 04/28/2023