Organization
BEACON MEDICAL GROUP INC
Active
Other names
Beacon Medical Group Bremen, Beacon Medical Group Bremen South Street
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P. COSTELLO (CFO)
(574) 647-3460
Entity
Organization
Contact information
Practice address
1144 W PLYMOUTH ST, BREMEN, IN 46506-1842
(574) 546-5363
(574) 546-2575
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/27/2018
Last updated
02/22/2024
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