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Contact Information

MED PAVILION PC
220A SW 26TH AVE
MINERAL WELLS, TX76067
 Phone: 940-325-1543
 Fax: 940-325-2679
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MED PAVILION PC · (Female)

NPI # 1871643007
Status Active
Credentials
Entity Individual
Enumeration date 01/11/2007
Last updated 02/13/2026 - About 4 months ago
Sole proprietor 1 Not specified
Identifiers
  • TX License # J4552
  • TX Medicaid 135150406
  • TX Medicaid 135150408
  • Other 80780Y BCBS
  • TX Other TXB158020 PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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