BEACON MEDICAL GROUP NPI 1689627812

NPI Information

  • NPI: 1689627812
  • Provider Name: BEACON MEDICAL GROUP
  • Classification: Urology - 208800000X
  • Entity Type: Organization
  • Doing Business As: MEMORIAL CHILDREN'S HOSPITAL NAVARRE PEDIATRICS
  • Address: 100 NAVARRE PL
    SUITE 4400
    SOUTH BEND, IN
    ZIP 46601
  • Phone: (574) 647-4535

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NPI Details

BEACON MEDICAL GROUP is an urology in South Bend, IN. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. BEACON MEDICAL GROUP NPI is 1689627812. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Memorial Children's Hospital Navarre Pediatrics.

The provider's business location address is:

100 NAVARRE PL
SUITE 4400
SOUTH BEND, IN
ZIP 46601-156
Phone: (574) 647-4535

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 enumeration date for this NPI number is 5/18/2006 and was last updated on 3/9/2016.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrology01024987AINDIANAYes

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
1225380MEDICARE PININDIANA
215D1038973OTHERINDIANACLIA NUMBER

What is NPI?

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This page was last updated on: 11/21/2025

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