| NPI | 1487038360 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP VEIN SPECIALISTS |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P. COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2017-10-12 |