# BEACON MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beacon Medical Group Sleep Medicine Elkhart East, Beacon Medical Group Sleep Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881925188
- **Authorized official:** MR. JEFFREY P COSTELLO (CFO)
- **Authorized official phone:** (574) 647-3549

## Contact information

- **Practice address:** 525 W BRISTOL ST, ELKHART, IN 46514-2964
- **Practice address phone:** (574) 262-0239
- **Practice address fax:** (574) 262-8391
- **Mailing address:** 3245 HEALTH DR STE 100, GRANGER, IN 46530-1380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2010
- **Last updated:** 05/05/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200977370 | — | IN |