BEACON MEDICAL GROUP INC. NPI 1124079330

NPI Information

BEACON MEDICAL GROUP, INC. is a family medicine in South Bend, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BEACON MEDICAL GROUP, INC. NPI is 1124079330. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Beacon Medical Group Ireland Road.

The provider's business location address is:

1815 E IRELAND RD
SOUTH BEND, IN
ZIP 46614-845
Phone: (574) 647-1700
Fax: (574) 291-3351

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 15D2100926 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 5/12/2006 and was last updated on 8/29/2016.

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:

Other Identifiers

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