BEACON MEDICAL GROUP INC. NPI 1821482431

NPI Information

  • NPI: 1821482431
  • Provider Name: BEACON MEDICAL GROUP, INC.
  • Classification: Obstetrics & Gynecology - 207VX0201X
  • Specialization: Gynecologic Oncology
  • Entity Type: Organization
  • Doing Business As: BMG WOMEN'S SURGICAL GYN/ONC @ MRCC
  • Address: 100 NAVARRE PL STE 4470
    SOUTH BEND, IN
    ZIP 46601
  • Phone: (574) 647-4230

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NPI Details

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 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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207VX0201XObstetrics & GynecologyGynecologic OncologyYes

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
1201285860AMEDICAIDINDIANA

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: 11/21/2025

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