Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Specialists Navarre, Beacon Medical Group Neurology, Beacon Medical Group North Central NeuroSurgery Elkhart, Beacon Medical Group North Central NeuroSurgery 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
100 NAVARRE PL STE 6600, SOUTH BEND, IN 46601-1173
(574) 647-8800
(574) 647-8811
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201003280A
—
IN
05
—
201003280B
—
IN
05
—
300041458
—
IN
Enumeration date
06/30/2006
Last updated
03/30/2026
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