| Organization Name: | BEACON MEDICAL GROUP INC |
| NPI Number: | 1124071246 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY COSTELLO (VP-CFO) |
| Mailing Address: | 100 Navarre Pl Suite 4470 South Bend |
| State: | IN US |
| Postal Code: | 466011156 |
| Phone Number: | 5746474230 |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2006 |
| NPI Last Update Date: | 05/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 01027434A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |