| Beacon Medical Group Middlebury | |
|
206 W Warren St Middlebury IN 46540-9410 | |
| (574) 825-2146 | |
| (574) 524-7435 |
| Full Name | Beacon Medical Group Middlebury |
|---|---|
| Speciality | Family Medicine |
| Location | 206 W Warren St, Middlebury, 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 Middlebury 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Middlebury 206 W Warren St Middlebury IN 46540-9410 Ph: (574) 825-2146 |
| NPI Number | 1114363835 |
|---|---|
| Provider Enumeration Date | 05/21/2013 |
| Last Update Date | 03/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114363835 | NPI | - | NPPES |
| 100114000G | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
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