Beacon Medical Group, Inc.
May also be knows as Beacon Medical Group Hospital Specialties
Legal Business Name
Beacon Medical Group, Inc.
Also Known As
Beacon Medical Group Hospital Specialties
NPI Number
1821222829
NPI Type
Organization
Enumeration Date
05/06/2009
Specialties
(Taxonomies)Name
Code
207RC0000X
207RC0200X
207Q00000X
207VF0040X
207VG0400X
207RI0200X
207X00000X
207YX0905X
207RP1001X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
Licenses
State
Indiana
License Number
01049858A
Contact
Information
Purpose
Mailing
Location
Address
3245 HEALTH DR STE 100
500 ARCADE AVE STE 320
City
Granger
Elkhart
State
IN
IN
Postal Code
46530-1380
46514-2477
Country
US
US
Telephone Number
(574) 647-1069
(574) 523-7900
Authorized Official
Name
Mr. Jeffrey Costello
Title or Position
VP/CFO
Telephone Number
(574) 647-3549
Identifiers
Identifier
300068062
300093527
300012878
300013260
300068474
300070471
300013073
300013675
Identifier State
IN
IN
IN
IN
IN
IN
IN
IN
Identifier Issuer
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 08/28/2024