NPI | 1124079330 |
---|---|
Doing Business As | BEACON MEDICAL GROUP IRELAND ROAD |
Entity Type | Organization |
Authorized Contact | JEFFREY COSTELLO VP CFO 574-647-3549 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01043622A) |
Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology |
363LF0000X Nurse Practitioner, Family | |
Enumeration Date | 2006-05-12 |
Last Update Date | 2024-03-04 |