| Beacon Medical Group Bittersweet Commons | |
|
12340 Bittersweet Commons Blvd W Granger IN 46530-6959 | |
| (574) 271-8610 | |
| (574) 271-8620 |
| Full Name | Beacon Medical Group Bittersweet Commons |
|---|---|
| Speciality | Family Medicine |
| Location | 12340 Bittersweet Commons Blvd W, Granger, 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 Bittersweet Commons 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Bittersweet Commons 12340 Bittersweet Commons Blvd W Granger IN 46530-6959 Ph: (574) 271-8610 |
| NPI Number | 1003042318 |
|---|---|
| Provider Enumeration Date | 06/02/2009 |
| Last Update Date | 04/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003042318 | NPI | - | NPPES |
| 000000631897 | Other | IN | ANTHEM |
| 100114000F | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Indiana) | Primary |
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