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BEACON MEDICAL GROUP INC. NPI 1831149525


NPI Information

NPI: 1831149525
Provider Name: BEACON MEDICAL GROUP, INC.
Classification: Orthopaedic Surgery - 207X00000X
Entity Type: Organization

CLIA Number: 15D2049288

Address:
100 NAVARRE PL STE 5500
SOUTH BEND, IN
ZIP 46601
Phone: (574) 647-5300
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BEACON MEDICAL GROUP, INC. is an orthopaedic surgery in South Bend, IN. The provider is an orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. BEACON MEDICAL GROUP, INC. NPI is 1831149525. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

100 NAVARRE PL STE 5500
SOUTH BEND, IN
ZIP 46601-172
Phone: (574) 647-5300
Fax: (574) 647-5305

The provider's authorized official is Jeffrey Costello .
The authorized official title is Vp-cfo and has the following contact phone number (574) 647-3549.

The CLIA number assigned to this NPI record is 15D2049288 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/11/2006 and was last updated on 10/12/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207X00000XOrthopaedic Surgery01055773AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1200241180AMEDICAIDINDIANA
2231860MEDICARE PININDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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