Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Maternal Fetal Medicine South Bend
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
100 NAVARRE PL STE 4410, SOUTH BEND, IN 46601-1171
(574) 647-6370
(574) 647-6373
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
Primary
01053966A
IN
2086S0102X
Surgical Critical Care Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300114652
—
IN
05
—
300125576
—
IN
Enumeration date
05/17/2006
Last updated
02/10/2026
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