Provider Demographics
NPI:1013357953
Name:DISCOVERY MEDICAL NETWORK HENRIETTA
Entity type:Organization
Organization Name:DISCOVERY MEDICAL NETWORK HENRIETTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-776-0607
Mailing Address - Street 1:1500 BROADWAY, SUITE 1000
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401
Mailing Address - Country:US
Mailing Address - Phone:806-791-1591
Mailing Address - Fax:
Practice Address - Street 1:412 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3348
Practice Address - Country:US
Practice Address - Phone:940-538-0454
Practice Address - Fax:940-235-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty