Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Occupational Health 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
2301 N BENDIX DR, SUITE 500, SOUTH BEND, IN 46628-3486
(574) 647-1675
(574) 232-5595
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 647-1825
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
Primary
01047560A
IN
363LF0000X
Family Nurse Practitioner
71000502A
IN
Other
Enumeration date
03/31/2008
Last updated
08/30/2016
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