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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