| Beacon Medical Group Edwardsburg | |
|
27082 W Main Street Edwardsburg MI 49112-9334 | |
| (269) 663-8288 | |
| (269) 663-2426 |
| Full Name | Beacon Medical Group Edwardsburg |
|---|---|
| Speciality | Family Medicine |
| Location | 27082 W Main Street, Edwardsburg, Michigan |
| Authorized Official Name and Position | Jeff P Costello (CFO) |
| Authorized Official Contact | 5746473549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Medical Group Edwardsburg 710 N Niles Ave South Bend IN 46617-1924 Ph: (574) 647-1610 | Beacon Medical Group Edwardsburg 27082 W Main Street Edwardsburg MI 49112-9334 Ph: (269) 663-8288 |
| NPI Number | 1205852365 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 05/03/2023 |
| Medicare PECOS PAC ID | 1254243306 |
|---|---|
| Medicare Enrollment ID | O20140124001781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205852365 | NPI | - | NPPES |
| 080A410090 | Medicaid | MI | |
| 100220310A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 06-005017-1 (Indiana) | Primary |
| Provider Name | Tamara L Riess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144281130 PECOS PAC ID: 3577466929 Enrollment ID: I20040202000018 |
| Provider Name | Mark P Schmeltz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487653408 PECOS PAC ID: 9739156720 Enrollment ID: I20041004000155 |
| Provider Name | Mary Helen P Havran-znavor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487650875 PECOS PAC ID: 4981673241 Enrollment ID: I20090219000283 |
| Provider Name | Lindsey Danielle Lira |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023231099 PECOS PAC ID: 4082787312 Enrollment ID: I20140114000520 |
| Provider Name | Cynthia Lynn Pascual |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962401091 PECOS PAC ID: 9739130352 Enrollment ID: I20181108001363 |
| Provider Name | Troy Weirick |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1679717771 PECOS PAC ID: 0840325361 Enrollment ID: I20211217001662 |
Healthy Cocoon Practice Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 27082 W. Main Street, Edwardsburg, MI 49112 Phone: 269-246-1375 Fax: 269-246-1376 | |
Advanced Practice Primary Care Staff Associates Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 27160 Deerfield Ln, Edwardsburg, MI 49112 Phone: 574-485-9541 |