Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Edwardsburg
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF P COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
27082 W MAIN STREET, EDWARDSBURG, MI 49112-9334
(269) 663-8288
(269) 663-2426
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
06-005017-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080A410090
—
MI
05
—
100220310A
—
IN
Enumeration date
07/14/2006
Last updated
05/03/2023
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