| Beacon Medical Group Main Street | |
|
6913 N Main St Ste 300 Granger IN 46530-8039 | |
| (574) 647-1500 | |
| (574) 647-2567 |
| Full Name | Beacon Medical Group Main Street |
|---|---|
| Speciality | Family Medicine |
| Location | 6913 N Main St Ste 300, Granger, 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 Main Street 3245 Health Dr Ste 100 Granger IN 46530-1380 Ph: () - | Beacon Medical Group Main Street 6913 N Main St Ste 300 Granger IN 46530-8039 Ph: (574) 647-1500 |
| NPI Number | 1053361543 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 08/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053361543 | NPI | - | NPPES |
| 300002852 | Medicaid | IN | |
| 100224050C | Medicaid | IN | |
| 300015362 | Medicaid | IN |
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