BEACON MEDICAL GROUP INC. NPI 1770775009

NPI Information

  • NPI: 1770775009
  • Provider Name: BEACON MEDICAL GROUP, INC.
  • Classification: Radiology - 2085R0001X
  • Specialization: Radiation Oncology
  • Entity Type: Organization
  • Doing Business As: BEACON MEDICAL GROUP ONCOLOGY ELKHART
  • Address: 621 MEMORIAL DR STE 100
    SOUTH BEND, IN
    ZIP 46601
  • Phone: (574) 647-1100

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NPI Details

BEACON MEDICAL GROUP, INC. is a radiation oncology radiology in South Bend, IN. The provider is a radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. BEACON MEDICAL GROUP, INC. NPI is 1770775009. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Beacon Medical Group Oncology Elkhart.

The provider's business location address is:

621 MEMORIAL DR STE 100
SOUTH BEND, IN
ZIP 46601-063
Phone: (574) 647-1100
Fax: (574) 647-5907

The provider's authorized official is Jeffrey P. 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 8/10/2007 and was last updated on 4/28/2023.

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
1207RH0003XInternal MedicineHematology & OncologyNo
22085R0001XRadiologyRadiation Oncology01021173AINDIANAYes

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
1300046000MEDICAIDINDIANA

What is NPI?

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

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