| NPI | 1053361543 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP PEDIATRICS MAIN STREET |
| Doing Business As | BEACON MEDICAL GROUP MAIN STREET |
| Entity Type | Organization |
| Authorized Contact | JEFFREY COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RR0500X Internal Medicine, Rheumatology | |
| 208000000X Pediatrics | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-08-26 |