Beacon Medical Group Sports Medicine South Bend

LBN: Beacon Medical Group, Inc.
Beacon Medical Group Sports Medicine South Bend is an health care organization with primary practice located at 111 W Jefferson Blvd Suite 100, South Bend IN 46601-1994. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as the primary health care specialty. Beacon Medical Group, Inc. can be contacted via phone (574) 647-1669, or through Costello, Jeffrey via phone (574) 647-3549.

Contact Information

Primary practice address
111 W Jefferson Blvd Suite 100 South Bend IN 46601-1994
Phone: (574) 647-1669
Fax: (574) 239-6461
Website:
Map and Directions
Authorized official contact:
Name: Costello, Jeffrey
Phone: (574) 647-3549

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 01049328A Indiana

Profile Details

NPI number 1578515151
LBN Legal business name Beacon Medical Group, Inc.
DBA Doing business as Beacon Medical Group Sports Medicine South Bend
Authorized official Costello, Jeffrey
Entity Organization
Organization subpart 1 No
Enumeration date May 16th, 2006
Last updated Aug 30th, 2016 - about 9 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 1578515151 NPPES
Indiana MEDICAID 200302560A

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