Healthcare Provider Details

I. General information

NPI: 1053672535
Provider Name (Legal Business Name): DISCOVERY MEDICAL NETWORK MATAGORDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOSPITAL CIR
BAY CITY TX
77414-4771
US

IV. Provider business mailing address

1500 BROADWAY STE 1000
LUBBOCK TX
79401-3179
US

V. Phone/Fax

Practice location:
  • Phone: 979-245-0001
  • Fax: 979-244-8103
Mailing address:
  • Phone: 806-791-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JJ WEBB
Title or Position: ADMINISTRATOR
Credential:
Phone: 806-776-0607