NPI 1588024624 · live from the CMS NPI Registry
Beacon Medical Group, INC.
Family Medicine in South Bend, IN. National Provider Identifier 1588024624, active.
NPI record
| NPI | 1588024624 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 2235 Cleveland Rd, South Bend, IN 46628 |
| Practice phone | 574-647-4530 |
| Mailing address | 710 N Niles Ave, South Bend, IN 46617 |
| Enumerated | March 2, 2016 |
| Last updated | February 22, 2024 |
| Authorized official | Jeffrey Costello, Vp-Cfo |
| Other names | Beacon Medical Group Cleveland Road |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine, Nephrology | 207RN0300X | — |
| Podiatrist, Foot & Ankle Surgery | 213ES0103X | — |
| Nurse Practitioner, Family | 363LF0000X | — |
| Family Medicine primary | 207Q00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.