MEDICARE: HANSON DISCOVERY GROUP LLC

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	261QM1300X	Multi-Specialty Clinic/Center
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1598380271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANSON DISCOVERY GROUP LLC

Provider Business Mailing Address
First Line	:	6002 LOFTY LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5087
Country	:	US
Telephone Number	:	832-618-4263
Fax Number	:

Provider Business Practice Location Address
First Line	:	6002 LOFTY LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5087
Country	:	US
Telephone Number	:	832-618-4263
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRYSTAL HEMPHILL
Credential	:
Telephone Number	:	281-804-8145

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	07/10/2020

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