Organization
BEACON MEDICAL GROUP, INC.
Active
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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