| Beacon Medical Group, Inc. | |
|
1506 Osolo Rd Ste C Elkhart IN 46514-4122 | |
| (574) 266-6050 | |
| (574) 262-8485 |
| Full Name | Beacon Medical Group, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1506 Osolo Rd Ste C, Elkhart, 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, Inc. 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 266-6050 | Beacon Medical Group, Inc. 1506 Osolo Rd Ste C Elkhart IN 46514-4122 Ph: (574) 266-6050 |
| NPI Number | 1114262078 |
|---|---|
| Provider Enumeration Date | 12/04/2012 |
| Last Update Date | 04/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114262078 | NPI | - | NPPES |
| 201120750B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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