Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Pediatrics Goshen, Beacon Medical Group Pediatrics Bristol Street, Beacon Medical Group Pediatrics Rieth Blvd
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P. COSTELLO (CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
1627 E BRISTOL ST, ELKHART, IN 46514-3817
(574) 262-0313
(574) 262-8163
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114000H
—
IN
05
—
100114000I
—
IN
05
—
300114876
—
IN
Enumeration date
02/12/2014
Last updated
08/12/2025
Update your record
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