Beacon Medical Group Portage Road

LBN: Beacon Medical Group, Inc.
Beacon Medical Group Portage Road is an health care organization with primary practice located at 3575 Portage Ave , South Bend IN 46628-6092. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Beacon Medical Group, Inc. can be contacted via phone (574) 647-4530, or through Costello, Jeffrey via phone (574) 647-3549.

Contact Information

Primary practice address
3575 Portage Ave South Bend IN 46628-6092
Phone: (574) 647-4530
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Costello, Jeffrey
Phone: (574) 647-3549

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01054535A Indiana

Profile Details

NPI number 1568413359
LBN Legal business name Beacon Medical Group, Inc.
DBA Doing business as Beacon Medical Group Portage Road
Authorized official Costello, Jeffrey
Entity Organization
Organization subpart 1 No
Enumeration date May 15th, 2006
Last updated Sep 27th, 2013 - about 13 years ago

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568413359 NPPES
Indiana MEDICAID 100092700B

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