MEDICARE: DISCOVER INTEGRATED MEDICAL CENTER, LTD.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1538775192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVER INTEGRATED MEDICAL CENTER, LTD.

Provider Business Mailing Address
First Line	:	2207 N US HIGHWAY 12 STE E
Second Line	:
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-9706
Country	:	US
Telephone Number	:	815-675-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2207 N US HIGHWAY 12 STE E
Second Line	:
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-9706
Country	:	US
Telephone Number	:	815-675-9355
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DARRIN FOSZCZ
Credential	:
Telephone Number	:	815-675-9355

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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