Organization
BEACON MEDICAL GROUP INC.
Active
Other names
Beacon Medical Group Concord Specialty Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
25651 COUNTY ROAD 20, ELKHART, IN 46517-2310
(574) 524-7128
(574) 296-6522
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Enumeration date
07/15/2014
Last updated
08/30/2016
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