Beacon Medical Group, Inc.

LBN: Beacon Medical Group, Inc.
Beacon Medical Group, Inc. is an health care organization with primary practice located at 813 S Michigan St , South Bend IN 46601. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Beacon Medical Group, Inc. can be contacted via phone (574) 647-2400, or through Costello, Jeffrey via phone (574) 647-3549.

Contact Information

Primary practice address
813 S Michigan St South Bend IN 46601
Phone: (574) 647-2400
Fax: (574) 647-4201
Website:
Map and Directions
Authorized official contact:
Name: Costello, Jeffrey
Phone: (574) 647-3549

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01022886A Indiana

Profile Details

NPI number 1275587149
LBN Legal business name Beacon Medical Group, Inc.
DBA Doing business as
Authorized official Costello, Jeffrey
Entity Organization
Organization subpart 1 No
Enumeration date May 22nd, 2006
Last updated Jul 3rd, 2018 - about 6 years 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275587149 NPPES
Indiana MEDICAID 200191560B
Indiana MEDICAID 200191560A

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