Provider Demographics
NPI:1538775192
Name:DISCOVER INTEGRATED MEDICAL CENTER, LTD.
Entity type:Organization
Organization Name:DISCOVER INTEGRATED MEDICAL CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSZCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-675-9355
Mailing Address - Street 1:2207 N US HIGHWAY 12 STE E
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-9706
Mailing Address - Country:US
Mailing Address - Phone:815-675-9355
Mailing Address - Fax:
Practice Address - Street 1:2207 N US HIGHWAY 12 STE E
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-9706
Practice Address - Country:US
Practice Address - Phone:815-675-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty