| NPI | 1942781109 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP BREMEN |
| Doing Business As | BEACON MEDICAL GROUP BREMEN SOUTH STREET |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P. COSTELLO CFO 574-647-3460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2024-02-22 |