Beacon Medical Group Ireland Road
LBN: Beacon Medical Group, Inc.
Beacon Medical Group Ireland Road is an health care organization with primary practice located at 1815 E Ireland Rd , South Bend IN 46614-2845. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Rheumatology, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Beacon Medical Group, Inc. can be contacted via phone (574) 647-1700, or through Costello, Jeffrey via phone (574) 647-3549.
Contact Information
Primary practice address
1815 E Ireland Rd
South Bend IN 46614-2845
Phone: (574) 647-1700
Fax: (574) 291-3351
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 01043622A | Indiana |
| Allopathic & Osteopathic Physicians / Rheumatology | 207RR0500X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X |
Profile Details
| NPI number | 1124079330 |
|---|---|
| LBN Legal business name | Beacon Medical Group, Inc. |
| DBA Doing business as | Beacon Medical Group Ireland Road |
| Authorized official | Costello, Jeffrey |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 12th, 2006 |
| Last updated | Mar 4th, 2024 - about 8 months ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124079330 | NPPES |
| Indiana | MEDICAID | 100224050B |
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