MEDICARE: MYDISCOVER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	0840	NH

General Provider Information

NPI Number	:	1023406592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYDISCOVER INC.

Provider Business Mailing Address
First Line	:	50 SEAVEY ST
Second Line	:	UNIT 2874
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5355
Country	:	US
Telephone Number	:	603-702-0117
Fax Number	:	603-509-2405

Provider Business Practice Location Address
First Line	:	50 SEAVEY ST
Second Line	:	UNIT 2874
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5355
Country	:	US
Telephone Number	:	603-702-0117
Fax Number	:	603-509-2405

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. PETER STONE
Credential	:	M.L.A.D.C.
Telephone Number	:	603-702-0117

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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