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BEACON MEDICAL GROUP INC. NPI 1205852365


NPI Information

NPI: 1205852365
Provider Name: BEACON MEDICAL GROUP, INC.

Doing Business As: BEACON MEDICAL GROUP EDWARDSBURG

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 23D0378216

Address:
27082 W MAIN STREET
EDWARDSBURG, MI
ZIP 49112
Phone: (269) 663-8288
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BEACON MEDICAL GROUP, INC. is a family medicine in Edwardsburg, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BEACON MEDICAL GROUP, INC. NPI is 1205852365. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Beacon Medical Group Edwardsburg.

The provider's business location address is:

27082 W MAIN STREET
EDWARDSBURG, MI
ZIP 49112-334
Phone: (269) 663-8288
Fax: (269) 663-2426

The provider's authorized official is Jeff P Costello .
The authorized official title is Cfo and has the following contact phone number (574) 647-3549.

The CLIA number assigned to this NPI record is 23D0378216 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/14/2006 and was last updated on 5/3/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine06-005017-1INDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1080A410090MEDICAIDMICHIGAN
2100220310AMEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.