| Beacon Medical Group Bristol | |
|
306 E Vistula Bristol IN 46507-9489 | |
| (574) 848-4427 | |
| (574) 848-4592 |
| Full Name | Beacon Medical Group Bristol |
|---|---|
| Speciality | Family Medicine |
| Location | 306 E Vistula, Bristol, Indiana |
| Authorized Official Name and Position | Jeffrey P Costello (CFO) |
| Authorized Official Contact | 5746473549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Medical Group Bristol 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Bristol 306 E Vistula Bristol IN 46507-9489 Ph: (574) 848-4427 |
| NPI Number | 1447285697 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 04/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447285697 | NPI | - | NPPES |
| 000000110755 | Other | IN | BCBS REMIT |
| 100114000B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 06-005017-1 (Indiana) | Primary |
Goshen Health System, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 304 E Vistula St, Bristol, IN 46507 Phone: 574-848-4039 Fax: 574-848-4076 |