Provider Demographics
NPI:1336418649
Name:DISCOVERY MEDICAL NETWORK, INC
Entity Type:Organization
Organization Name:DISCOVERY MEDICAL NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-791-1591
Mailing Address - Street 1:2950 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4326
Mailing Address - Country:US
Mailing Address - Phone:806-791-1591
Mailing Address - Fax:
Practice Address - Street 1:146 E HOSPITAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4169
Practice Address - Country:US
Practice Address - Phone:806-791-1591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty