Beacon Medical Group Pediatric Multi-Specialty

LBN: Beacon Medical Group, Inc.
Beacon Medical Group Pediatric Multi-Specialty is an health care organization with primary practice located at 100 Navarre Pl Ste 5550 , South Bend IN 46601-1169. The organization recently has 6 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical, Dietary & Nutritional Service Providers / Dietitian, Registered, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Allopathic & Osteopathic Physicians / Pediatrics is the primary health care specialty. Beacon Medical Group, Inc. can be contacted via phone (574) 647-2550, or through Costello, Jeffrey P via phone (574) 647-3549.

Contact Information

Primary practice address
100 Navarre Pl Ste 5550 South Bend IN 46601-1169
Phone: (574) 647-2550
Fax: (574) 647-1129
Website:
Map and Directions
Authorized official contact:
Name: Costello, Jeffrey P
Phone: (574) 647-3549

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 01065535A Indiana
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X

Profile Details

NPI number 1548415474
LBN Legal business name Beacon Medical Group, Inc.
DBA Doing business as Beacon Medical Group Pediatric Multi-Specialty
Authorized official Costello, Jeffrey P
Entity Organization
Organization subpart 1 No
Enumeration date Nov 19th, 2008
Last updated Mar 4th, 2024 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548415474 NPPES
Indiana MEDICAID 200928880A
Indiana MEDICAID 300069919

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