| NPI | 1578515151 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP SPORTS MEDICINE SOUTH BEND |
| Entity Type | Organization |
| Authorized Contact | JEFFREY COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01049328A) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-08-30 |