BEACON MEDICAL GROUP INC. NPI 1316073372

NPI Information

  • NPI: 1316073372
  • Provider Name: BEACON MEDICAL GROUP, INC.
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Organization
  • Doing Business As: BEACON MEDICAL GROUP OBGYN RIVER OAKS LAWN AENUE
  • Address: 1215 LAWN AVE STE 100
    ELKHART, IN
    ZIP 46514
  • Phone: (574) 293-2893

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NPI Details

BEACON MEDICAL GROUP, INC. is an obstetrics gynecology in Elkhart, IN. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. BEACON MEDICAL GROUP, INC. NPI is 1316073372. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Beacon Medical Group Obgyn River Oaks Lawn Aenue.

The provider's business location address is:

1215 LAWN AVE STE 100
ELKHART, IN
ZIP 46514-450
Phone: (574) 293-2893
Fax: (574) 293-1298

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

The enumeration date for this NPI number is 2/26/2007 and was last updated on 3/4/2024.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & Gynecology07-005017-1INDIANAYes
2363LF0000XNurse PractitionerFamilyNo
3367A00000XAdvanced Practice MidwifeNo

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200853000AMEDICAIDINDIANA
2000000519823OTHERINDIANAANTHEM BCBS

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: 11/21/2025

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