Organization
BEACON MEDICAL GROUP INC
Active
Organization
BEACON MEDICAL GROUP INC
Active
Other names
Beacon Medical Group Anesthesia Elkhart
Organization subpart
No
Provider details
NPI number
Authorized official
IRENE MAFFETONE (CONTRACTING SPECIALIST)
(574) 647-1040
Entity
Organization
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 524-8130
(574) 524-8138
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300060722
—
IN
Enumeration date
02/10/2022
Last updated
10/14/2024
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