Organization
BEACON MEDICAL GROUP, INC.
Active
Parent organization
BEACON HEALTH SYSTEM, INC.
Other names
Beacon Medical Group Vein Specialists
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEACON HEALTH SYSTEM, INC.
Authorized official
MR. JEFFREY P. COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
233 FLORENCE AVE, GRANGER, IN 46530-8048
(574) 647-3990
(574) 647-3995
Mailing address
710 E NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Enumeration date
07/10/2015
Last updated
10/12/2017
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