| NPI | 1699794057 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP GASTROENTEROLOGY ELKHART |
| Doing Business As | BEACON MEDICAL GROUP GASTROENTEROLOGY SOUTH BEND |
| Doing Business As | BEACON MEDICAL GROUP GI AND INTERVENTIONAL RADIOLOGY |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: IN 06-005017-1) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology |
| 208800000X Urology | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-11-06 |