Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Advanced Cardiovascular Specialists Riverpointe
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
500 ARCADE AVE STE 400, ELKHART, IN 46514-2487
(574) 522-2284
(574) 522-3952
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
11-005017-1
IN
207RC0001X
Clinical Cardiac Electrophysiology Physician
11-005017-1
IN
207RI0011X
Interventional Cardiology Physician
11-005017-1
IN
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201004850B
—
IN
Enumeration date
01/04/2011
Last updated
02/22/2024
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