| NPI | 1770775009 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP ONCOLOGY SOUTH BEND |
| Doing Business As | BEACON MEDICAL GROUP ONCOLOGY ELKHART |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P. COSTELLO VP CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IN 01021173A) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2023-04-28 |