Provider Demographics
NPI:1134973084
Name:DISCOVER DIAGNOSTIC LABORATORY, LLC
Entity type:Organization
Organization Name:DISCOVER DIAGNOSTIC LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-257-0569
Mailing Address - Street 1:702 S ILLINOIS AVE STE B104
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7974
Mailing Address - Country:US
Mailing Address - Phone:855-314-3337
Mailing Address - Fax:888-965-6670
Practice Address - Street 1:110 CYPRESS STATION DR STE 117
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1626
Practice Address - Country:US
Practice Address - Phone:424-999-8698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory