Organization · NPI-2

Beacon Medical Group, INC.

Family Medicine · Mishawaka, IN

NPI number1275550899

StatusActive

Last updated in NPPESMar 18, 2026

Details

NPI: 1275550899
Entity type: Organization (NPI-2)
Legal business name: Beacon Medical Group, INC.
Organization subpart: No
Enumeration date: Jul 17, 2006
Certification date: Mar 18, 2026
Last updated: Mar 18, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	–	–	Yes
363LF0000X	Nurse Practitioner, Family	–	–
207V00000X	Obstetrics & Gynecology	–	–
1041C0700X	Social Worker, Clinical	–	–
363LW0102X	Nurse Practitioner, Women's Health	–	–
207RC0000X	Internal Medicine, Cardiovascular Disease	–	–
207RI0011X	Internal Medicine, Interventional Cardiology	–	–
367A00000X	Advanced Practice Midwife	–	–

Other names

Beacon Medical Group Mishawaka (Doing Business As)

Practice location

5314 Lincolnway E
Mishawaka, IN 46544-4249

Phone 574-584-2812 · Fax 574-584-2813

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Phone 574-647-2129

Other practice locations

202 Lincolnway E Ste 201
Mishawaka, IN 46544-2079

Phone 574-584-2812 · Fax 574-584-2813

Authorized official

Jeffrey P Costello
Cfo
5746473549

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