| Beacon Medical Group Wanee | |
|
2102 N Main St Nappanee IN 46550-9310 | |
| (574) 862-2165 | |
| (574) 862-4112 |
| Full Name | Beacon Medical Group Wanee |
|---|---|
| Speciality | Family Medicine |
| Location | 2102 N Main St, Nappanee, 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 Wanee 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Wanee 2102 N Main St Nappanee IN 46550-9310 Ph: (574) 862-2165 |
| NPI Number | 1457378069 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 04/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457378069 | NPI | - | NPPES |
| 300054202 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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