Provider Type Icon

BEACON MEDICAL GROUP INC. NPI 1548415474


NPI Information

NPI: 1548415474
Provider Name: BEACON MEDICAL GROUP, INC.

Doing Business As: BEACON MEDICAL GROUP PEDIATRIC MULTI-SPECIALTY

Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
100 NAVARRE PL STE 5550
SOUTH BEND, IN
ZIP 46601
Phone: (574) 647-2550
Get Directions

BEACON MEDICAL GROUP, INC. is a pediatrics in South Bend, IN. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. BEACON MEDICAL GROUP, INC. NPI is 1548415474. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Beacon Medical Group Pediatric Multi-specialty.

The provider's business location address is:

100 NAVARRE PL STE 5550
SOUTH BEND, IN
ZIP 46601-169
Phone: (574) 647-2550
Fax: (574) 647-1129

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

The enumeration date for this NPI number is 11/19/2008 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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103T00000XPsychologistNo
2103TC0700XPsychologistClinicalNo
3133V00000XDietitian, RegisteredNo
4208000000XPediatrics01065535AINDIANAYes
52080N0001XPediatricsNeonatal-Perinatal MedicineNo
6363L00000XNurse PractitionerNo

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
1200928880AMEDICAIDINDIANA
2300069919MEDICAIDINDIANA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.