BEACON MEDICAL GROUP INC. NPI 1821482431

NPI Information

BEACON MEDICAL GROUP, INC. is a gynecologic oncology obstetrics gynecology in South Bend, IN. The provider is an obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. BEACON MEDICAL GROUP, INC. NPI is 1821482431. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Bmg Women's Surgical Gyn/onc @ Mrcc.

The provider's business location address is:

100 NAVARRE PL STE 4470
SOUTH BEND, IN
ZIP 46601-168
Phone: (574) 647-4230
Fax: (574) 647-4235

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 CLIA number assigned to this NPI record is 15D2098527 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/20/2015 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:

Other Identifiers

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