Organization
BEACON MEDICAL GROUP, INC.
Active
Parent organization
BEACON HEALTH SYSTEM, INC.
Other names
BMG Women's Surgical GYN/Onc @ MRCC
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
100 NAVARRE PL STE 4470, SOUTH BEND, IN 46601-1168
(574) 647-4230
(574) 647-4235
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201285860A
—
IN
Enumeration date
03/20/2015
Last updated
04/28/2023
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