| NPI | 1780856724 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP OCCUPATIONAL HEALTH SOUTH BEND |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P. COSTELLO VP/CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 01047560A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71000502A) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2016-08-30 |