Organization
BEACON MEDICAL GROUP, INC.
Active
Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Advanced Cardiology Specialists 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
610 N MICHIGAN ST STE 400, SOUTH BEND, IN 46601-1081
(574) 647-8120
(574) 647-8111
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01045628A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200921930A
—
IN
05
—
200921930D
—
IN
Enumeration date
04/28/2008
Last updated
04/24/2023
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