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Contact Information

BEACON MEDICAL GROUP, INC.
100 NAVARRE PL STE 4470
SOUTH BEND, IN46601-1168
 Phone: 574-647-1405
 Fax: 574-647-3970
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Advanced Practice Midwife

367A00000X 42 Certified Nurse Midwife
 

Obstetrics & Gynecology

207V00000X 16 Physician/Obstetrics & Gynecology
 

Women's Health

363LW0102X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for BEACON MEDICAL GROUP, INC.

NPI # 1578862181
LBN Legal business name BEACON MEDICAL GROUP, INC.
Authorized official JEFFREY COSTELLO - (VP/CFO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 03/22/2011
Last updated 01/30/2025 - More than a year ago
Identifiers
IN Medicaid 201020740A
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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