Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Parent organization
BEACON HEALTH SYSTEM, INC.
Other names
Beacon Medical Group Pulmonology and General Surgery
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEACON HEALTH SYSTEM, INC.
Authorized official
JEFFREY P. COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
500 ARCADE AVE STE 210, ELKHART, IN 46514-2485
(574) 389-5656
(574) 523-7891
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
208600000X
Surgery Physician
—
—
Other
Enumeration date
10/14/2015
Last updated
04/28/2023
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