Provider Demographics
NPI:1962705616
Name:DISCHARGE MD, LLC
Entity type:Organization
Organization Name:DISCHARGE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINH
Authorized Official - Middle Name:C
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-444-0101
Mailing Address - Street 1:12425 W BELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9002
Mailing Address - Country:US
Mailing Address - Phone:623-374-7774
Mailing Address - Fax:623-240-1110
Practice Address - Street 1:12425 W BELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9002
Practice Address - Country:US
Practice Address - Phone:623-374-7774
Practice Address - Fax:623-240-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113942Medicaid
I24298Medicare UPIN
AZ113942Medicaid