| Beacon Medical Group E. Blair Warner | |
|
714 N Michigan St South Bend IN 46601-1035 | |
| (574) 647-7477 | |
| (574) 647-3655 |
| Full Name | Beacon Medical Group E. Blair Warner |
|---|---|
| Speciality | Family Medicine |
| Location | 714 N Michigan St, South Bend, Indiana |
| Authorized Official Name and Position | Jeffrey Costello (VP-CFO) |
| Authorized Official Contact | 5746473549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Medical Group E. Blair Warner 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group E. Blair Warner 714 N Michigan St South Bend IN 46601-1035 Ph: (574) 647-7477 |
| NPI Number | 1609828946 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 07/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609828946 | NPI | - | NPPES |
| 100092670B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01034518A (Indiana) | Primary |
| 207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Secondary |
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