Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Memorial Children's Hospital Navarre Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
100 NAVARRE PL STE 4440, SOUTH BEND, IN 46601-1171
(574) 647-4540
(574) 647-4542
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01046281A
IN
Other
Enumeration date
05/18/2006
Last updated
04/04/2019
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