Beacon Medical Group Bristol | |
306 E Vistula Bristol IN 46507-9489 | |
(574) 848-4427 | |
(574) 848-4592 |
Full Name | Beacon Medical Group Bristol |
---|---|
Speciality | Family Medicine |
Location | 306 E Vistula, Bristol, Indiana |
Authorized Official Name and Position | Jeffrey P Costello (CFO) |
Authorized Official Contact | 5746473549 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Beacon Medical Group Bristol 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Bristol 306 E Vistula Bristol IN 46507-9489 Ph: (574) 848-4427 |
NPI Number | 1447285697 |
---|---|
Provider Enumeration Date | 07/12/2006 |
Last Update Date | 04/24/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447285697 | NPI | - | NPPES |
000000110755 | Other | IN | BCBS REMIT |
100114000B | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 06-005017-1 (Indiana) | Primary |
News Archive
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