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Contact Information

BEACON MEDICAL GROUP, INC.
707 N MICHIGAN ST STE 400
SOUTH BEND, IN46601-1071
 Phone: 574-647-8470
 Fax: 574-647-8475
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Geriatric Psychiatry

2084P0805X 86 Physician/Neuropsychiatry
 

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for BEACON MEDICAL GROUP INC · (Female)

NPI # 1629376645
Status Active
Credentials
Entity Individual
Enumeration date 03/01/2011
Last updated 02/22/2024 - About 2 years ago
Sole proprietor 1 Not specified
Identifiers
  • IN License # 01052982A
  • IN Medicaid 201013730A
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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