Beacon Medical Group Inc
Organization Active NPI Obstetrics & Gynecology Physician · South Bend, IN
NPI 1124071246 · NPPES record last updated Aug 30, 2016
Key facts
- NPI
- 1124071246
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 01027434A (IN)
- Legal business name
- BEACON MEDICAL GROUP INC
- Practice address
- 100 Navarre PL
Suite 4470
South Bend, IN 46601-1156 - Phone
- (574) 647-4230
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Jeffrey Costello
- Title
- VP-Cfo
- Phone
- (574) 647-3549
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031105000657 | IN | Part B Supplier - Clinic/Group Practice | 1254243306 |
Receives reassigned benefits from 737 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | 01027434A | IN | Yes |
Addresses
Primary practice location
100 Navarre PL
Suite 4470
South Bend, IN 46601-1156
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other names
- Women's Reproductive Medicine
Other providers in South Bend, IN
- Beacon Health Ventures Inc
- Beacon Health Ventures, Inc
- Beacon Health Ventures, Inc.
- Beacon Health Ventures, Inc.
- Beacon Medical Group
- Beacon Medical Group Inc
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
All providers in South Bend, IN · Obstetrics & Gynecology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.