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Contact Information

BEACON MEDICAL GROUP, INC.
100 NAVARRE PL STE 4410
SOUTH BEND, IN46601-1171
 Phone: 574-647-6370
 Fax: 574-647-6373
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Maternal & Fetal Medicine

207VM0101X 16 Physician/Obstetrics & Gynecology
 

Family

363LF0000X 50 Nurse Practitioner
 

Genetic Counselor, MS

170300000X
 

Obstetrics & Gynecology

207V00000X 16 Physician/Obstetrics & Gynecology
 

Surgical Critical Care

2086S0102X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for BEACON MEDICAL GROUP, INC.

NPI # 1710939608
LBN Legal business name BEACON MEDICAL GROUP, INC.
Authorized official JEFFREY COSTELLO - (VP-CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 05/17/2006
Last updated 02/10/2026 - About 4 months ago
Identifiers
IN License # 01053966A
IN Medicaid 300125576
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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