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Contact Information

BEACON MEDICAL GROUP, INC.
621 MEMORIAL DR STE 100
SOUTH BEND, IN46601-1063
 Phone: 574-647-1100
 Fax: 574-647-5907
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Radiation Oncology

2085R0001X 92 Physician/Radiation Oncology
 

Hematology & Oncology

207RH0003X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for BEACON MEDICAL GROUP, INC.

NPI # 1770775009
LBN Legal business name BEACON MEDICAL GROUP, INC.
Authorized official JEFFREY COSTELLO - (VP-CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 08/10/2007
Last updated 04/28/2023 - About 3 years ago
Identifiers
IN License # 01021173A
IN Medicaid 300046000
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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