Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
MedPoint Express
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P. COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
926 ERSKINE PLZ, SOUTH BEND, IN 46614-3244
(800) 635-5516
(574) 647-6514
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000651A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200130710H
—
IN
05
—
200130710I
—
IN
05
—
200130710J
—
IN
05
—
200130710K
—
IN
Enumeration date
05/16/2006
Last updated
08/29/2016
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