Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Portage Road
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
3575 PORTAGE AVE, SOUTH BEND, IN 46628-6092
(574) 647-4530
Mailing address
53842 GENERATIONS DR, SOUTH BEND, IN 46635-1543
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01054535A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092700B
—
IN
Enumeration date
05/15/2006
Last updated
09/27/2013
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us