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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.

NPI # 1629376645
LBN Legal business name BEACON MEDICAL GROUP, INC.
Authorized official JEFFREY COSTELLO - (VP/CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 03/01/2011
Last updated 02/22/2024 - About 2 years ago
Identifiers
IN License # 01052982A
IN Medicaid 201013730A
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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