| 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 | 207QS0010X Family Medicine Sports Medicine |
| 207RR0500X Internal Medicine Rheumatology | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-09-30 |