| Med Pavilion Pc | |
|
220a Sw 26th Ave Mineral Wells TX 76067 | |
| (940) 325-1543 | |
| (940) 325-2679 |
| Full Name | Med Pavilion Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 220a Sw 26th Ave, Mineral Wells, Texas |
| Authorized Official Name and Position | Marisella Navarrete (RECEPTIONIT) |
| Authorized Official Contact | 9403251543 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Med Pavilion Pc 220a Sw 26th Ave Mineral Wells TX 76067 Ph: (940) 325-1543 | Med Pavilion Pc 220a Sw 26th Ave Mineral Wells TX 76067 Ph: (940) 325-1543 |
| NPI Number | 1871643007 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 03/28/2017 |
| Medicare PECOS PAC ID | 6901052794 |
|---|---|
| Medicare Enrollment ID | O20120810000020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871643007 | NPI | - | NPPES |
| 80780Y | Other | BCBS | |
| 135150408 | Medicaid | TX | |
| 135150406 | Medicaid | TX | |
| TXB158020 | Other | TX | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | J4552 (Texas) | Primary |
| 208000000X | Pediatrics | J4552 (Texas) | Secondary |
| Provider Name | Tom A Tarkenton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306824651 PECOS PAC ID: 0345294286 Enrollment ID: I20050303000714 |
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