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Organization
MED PAVILION PC
Active
Organization
MED PAVILION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY R WRIGHT LVN (CLINIC COORDINATOR)
(940) 325-1543
Entity
Organization
Contact information
Practice address
220A SW 26TH AVE, MINERAL WELLS, TX 76067
(940) 325-1543
(940) 325-2679
Mailing address
220A SW 26TH AVE, MINERAL WELLS, TX 76067-8248
(940) 325-1543
(940) 325-2679
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
J4552
TX
208000000X
Pediatrics Physician
J4552
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135150406
—
TX
05
—
135150408
—
TX
01
—
80780Y
BCBS
—
01
—
TXB158020
PTAN
TX
Enumeration date
01/11/2007
Last updated
02/13/2026
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