Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Three Rivers Specialty Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P. COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
711 S HEALTH PARKWAY, THREE RIVERS, MI 49093-9387
(269) 273-9698
(269) 273-9699
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207Y00000X
Otolaryngology Physician
—
—
Other
Enumeration date
02/26/2014
Last updated
04/24/2023
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