| NPI | 1548415474 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP PEDIATRIC MULTI-SPECIALTY |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO Vice President/CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IN 01065535A) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist Clinical | |
| 133V00000X Dietitian, Registered | |
| 2080N0001X Pediatrics Neonatal-Perinatal Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2024-03-04 |