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Contact Information

BEACON MEDICAL GROUP WEIGHT LOSS AND BARIATRIC SURGERY
LBN BEACON MEDICAL GROUP, INC.
6913 N MAIN ST STE 100
GRANGER, IN46530
 Phone: 574-647-6400
 Fax: 574-647-2951
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endocrinology, Diabetes & Metabolism

207RE0101X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for BEACON MEDICAL GROUP WEIGHT LOSS AND BARIATRIC SURGERY

NPI Number 1306899554
LBN Legal business name BEACON MEDICAL GROUP, INC.
DBA Doing business as BEACON MEDICAL GROUP WEIGHT LOSS AND BARIATRIC SURGERY
Authorized official JEFFREY COSTELLO - (VP-CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 05/18/2006
Last updated 06/06/2018 - More than a year ago
Identifiers
IN License # 01050722A
IN Medicaid 100224050D
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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