Provider Demographics
NPI:1679909915
Name:DISCOVERY MEDICAL NETWORK MATAGORDA, LLC
Entity type:Organization
Organization Name:DISCOVERY MEDICAL NETWORK MATAGORDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JJ
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-791-1591
Mailing Address - Street 1:1500 BROADWAY STE 1000
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3179
Mailing Address - Country:US
Mailing Address - Phone:806-791-1591
Mailing Address - Fax:
Practice Address - Street 1:600 HOSPITAL CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4755
Practice Address - Country:US
Practice Address - Phone:979-241-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty