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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