<Unavail>
LBN: Beacon Medical Group, Inc.
<Unavail> is an health care organization with primary practice located at 4630 Vistula Rd , Mishawaka IN 46544-4000. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Beacon Medical Group, Inc. can be contacted via phone (574) 647-1900, or through Costello, Jeffrey via phone (574) 647-3549.
Contact Information
Primary practice address
4630 Vistula Rd
Mishawaka IN 46544-4000
Phone: (574) 647-1900
Fax: (574) 254-7222
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 01058339A | Indiana |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | ||
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X |
Profile Details
| NPI number | 1033161617 |
|---|---|
| LBN Legal business name | Beacon Medical Group, Inc. |
| DBA Doing business as | <Unavail> |
| Authorized official | Costello, Jeffrey |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 16th, 2006 |
| Last updated | Feb 13th, 2025 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033161617 | NPPES |
| Indiana | MEDICAID | 200130710A |
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