Organization
BEACON MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
813 S MICHIGAN ST, SOUTH BEND, IN 46601
(574) 647-2400
(574) 647-4201
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01022886A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200191560A
—
IN
05
—
200191560B
—
IN
Enumeration date
05/22/2006
Last updated
07/03/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us