Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Oncology Elkhart, Beacon Medical Group Oncology South Bend
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P. COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
621 MEMORIAL DR STE 100, SOUTH BEND, IN 46601-1063
(574) 647-1100
(574) 647-5907
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1817
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
—
—
2085R0001X
Radiation Oncology Physician
Primary
01021173A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300046000
—
IN
Enumeration date
08/10/2007
Last updated
04/28/2023
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