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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