Organization
BEACON MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
1753 FULTON ST, ELKHART, IN 46514-1927
(574) 293-9448
(574) 293-9480
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
—
231H00000X
Audiologist
—
—
Other
Enumeration date
10/10/2012
Last updated
10/12/2017
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