Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group GI and Interventional Radiology, Beacon Medical Group Gastroenterology South Bend, Beacon Medical Group Urology Elkhart, Beacon Medical Group Urology Goshen
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 300, ELKHART, IN 46514-2486
(574) 389-7362
(574) 389-5612
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
06-005017-1
IN
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300042826
—
IN
05
—
300054801
—
IN
05
—
300098369
—
IN
05
—
300098524
—
IN
Enumeration date
07/18/2006
Last updated
06/13/2025
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