NPI 1639196249 · live from the CMS NPI Registry
Beacon Medical Group, INC.
Family Medicine in Elkhart, IN. National Provider Identifier 1639196249, active.
NPI record
| NPI | 1639196249 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 3301 County Road 6 E, Elkhart, IN 46514 |
| Practice phone | 574-264-9635 |
| Mailing address | 3245 Health Dr Ste 100, Granger, IN 46530 |
| Enumerated | July 17, 2006 |
| Last updated | February 5, 2025 |
| Authorized official | Jeffrey Costello, Cfo |
| Other names | Beacon Medical Group-Elkhart East |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine primary | 207Q00000X | — |
| Internal Medicine | 207R00000X | — |
| Internal Medicine, Nephrology | 207RN0300X | — |
| Orthopaedic Surgery | 207X00000X | — |
| Podiatrist, Foot & Ankle Surgery | 213ES0103X | — |
| Nurse Practitioner, Family | 363LF0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.