OrganizationActive
Beacon Medical Group, Inc.
NPI 1174927131 · Trauma Surgery Physician · South Bend, IN
Provider details
- NPI number
- 1174927131
- Entity type
- Organization
- Primary specialty
- Trauma Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jeffrey Costello, Cfo(574) 647-3549
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Surgery Physician208600000X
Allopathic & Osteopathic Physicians
- Vascular Surgery Physician2086S0129X
Allopathic & Osteopathic Physicians
Practice location
621 Memorial Dr Ste 502
South Bend, IN 46601-1075
Phone: (574) 647-5875
Fax: (574) 647-5878
Approximate (ZIP-level) locationGet directions
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Other names (DBA / former)
- Doing business as
- Beacon Medical Group- Trauma and Surgical Services
- Doing business as
- Beacon Medical Group- Trauma and Surgical Services
Registry dates
- Enumerated
- 2014-10-20
- Last updated
- 2023-04-24
- Certified
- 2023-04-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.