Beacon Medical Group Pediatrics Bristol Street

LBN: Beacon Medical Group, Inc.
Beacon Medical Group Pediatrics Bristol Street is an health care organization with primary practice located at 1627 E Bristol St , Elkhart IN 46514-3817. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as the primary health care specialty. Beacon Medical Group, Inc. can be contacted via phone (574) 262-0313, or through Costello, Jeffrey P. via phone (574) 647-3549.

Contact Information

Primary practice address
1627 E Bristol St Elkhart IN 46514-3817
Phone: (574) 262-0313
Fax: (574) 262-8163
Website:
Map and Directions
Authorized official contact:
Name: Costello, Jeffrey P.
Phone: (574) 647-3549

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X

Profile Details

NPI number 1861816761
LBN Legal business name Beacon Medical Group, Inc.
DBA Doing business as Beacon Medical Group Pediatrics Bristol Street
Authorized official Costello, Jeffrey P.
Entity Organization
Organization subpart 1 No
Enumeration date Feb 12th, 2014
Last updated Apr 28th, 2023 - about 2 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 1861816761 NPPES
Indiana MEDICAID 100114000I
Indiana MEDICAID 100114000H

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