Beacon Medical Group, INC.
Family Medicine in Elkhart, IN. Organization (NPI-2).
NPI number1639196249
StatusActive
Last updated in NPPESFeb 5, 2025
Details
- NPI
- 1639196249
- Entity type
- Organization (NPI-2)
- Legal business name
- Beacon Medical Group, INC.
- Organization subpart
- No
- Enumeration date
- Jul 17, 2006
- Certification date
- Feb 5, 2025
- Last updated
- Feb 5, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 207R00000X | Internal Medicine | – | – | |
| 207RN0300X | Internal Medicine, Nephrology | – | – | |
| 207X00000X | Orthopaedic Surgery | – | – | |
| 213ES0103X | Podiatrist, Foot & Ankle Surgery | – | – | |
| 363LF0000X | Nurse Practitioner, Family | – | – |
Other names
- Beacon Medical Group-Elkhart East (Doing Business As)
Practice location
3301 County Road 6 EElkhart, IN 46514-7673
Phone 574-264-9635 · Fax 574-262-0398
Mailing address
3245 Health Dr Ste 100Granger, IN 46530-1380
Phone 574-647-1610 · Fax 574-237-6069
Authorized official
Jeffrey P Costello
Cfo
5746473549
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