Organization · Type 2 NPI

Beacon Medical Group, Inc.

Radiation Oncology Physician · South Bend, IN

NPI number 1770775009 Active

Practice location

621 Memorial Dr Ste 100
South Bend, IN 46601-1063

Call (574) 647-1100 Map

Fax (574) 647-5907

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924

Other practice locations

1215 Lawn Ave Ste 120, Elkhart, IN 46514-2450 · (574) 523-2733

Specialties and licenses

Taxonomy	Code	License
Hematology & Oncology Physician	207RH0003X	None listed
Radiation Oncology Physician Primary	2085R0001X	01021173A (IN)

Radiation Oncology Physician: A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.

5 other providers at this address

Other radiation oncology physician providers in South Bend

Radiation Oncology Associates of Michiana PCRadiation Oncology Physician South Bend, IN NPI 1073569174

See all in South Bend →

NPI record

NPI: 1770775009
Entity type: Organization (Type 2)
Issued: Aug 10, 2007
Last updated: Apr 28, 2023
Status: Active

Other names

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Beacon Medical Group Oncology Elkhart · doing business as
Beacon Medical Group Oncology South Bend · doing business as

Authorized official

Mr. Jeffrey P. Costello
VP-CFO
(574) 647-3549

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1770775009

Beacon Medical Group, Inc.'s National Provider Identifier is 1770775009, issued on Aug 10, 2007. The primary taxonomy on file is Radiation Oncology Physician (2085R0001X), and the practice location is in South Bend, IN. The record was last updated on Apr 28, 2023.