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BEACON MEDICAL GROUP INC. NPI 1710939608


NPI Information

NPI: 1710939608
Provider Name: BEACON MEDICAL GROUP, INC.

Doing Business As: BEACON MEDICAL GROUP MATERNAL FETAL MEDICINE SOUTH BEND

Classification: Obstetrics & Gynecology - 207VM0101X
Entity Type: Organization

Specialization: Maternal & Fetal Medicine

Address:
100 NAVARRE PL STE 4410
SOUTH BEND, IN
ZIP 46601
Phone: (574) 647-1650
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BEACON MEDICAL GROUP, INC. is a maternal and fetal medicine obstetrics gynecology in South Bend, IN. The provider is an obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies. BEACON MEDICAL GROUP, INC. NPI is 1710939608. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Beacon Medical Group Maternal Fetal Medicine South Bend.

The provider's business location address is:

100 NAVARRE PL STE 4410
SOUTH BEND, IN
ZIP 46601-171
Phone: (574) 647-1650
Fax: (574) 647-1655

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 5/17/2006 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
1207VM0101XObstetrics & GynecologyMaternal & Fetal Medicine01053966AINDIANAYes

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
1181980MEDICARE PININDIANA
2200332580AMEDICAIDINDIANA

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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