Med Pavilion PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

J4552 Issued in TX

Legal business name

MED PAVILION PC

Practice address

220A SW 26TH Ave
Mineral Wells, TX 76067

Phone

(940) 325-1543

Fax

(940) 325-2679

NPI assigned

Jan 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ashley R Wright, LVN

Title

Clinic Coordinator

Phone

(940) 325-1543

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tom Allen Tarkenton, D.O.

  • Internal Medicine Physician
  • Mineral Wells, TX
  • NPI 1306824651
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1871643007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220A SW 26TH AVE",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760678248",
            "telephone_number": "940-325-1543",
            "fax_number": "940-325-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220A SW 26TH AVE",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "76067",
            "telephone_number": "940-325-1543",
            "fax_number": "940-325-2679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED PAVILION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CLINIC COORDINATOR",
        "authorized_official_telephone_number": "940-325-1543",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J4552",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J4552",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "80780Y",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135150408",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135150406",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "TXB158020",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayme McIntosh, APRN, AGNP-C
• Jeffery W McKamey, CRNA
• Tyler Brandon McLemore, OD
• Colleen McNicholas-Hendrix, NP
• Meals on Wheels of Palo Pinto County, Inc.
• Mary Kwaa Mens, RN, FNP-C
• Sarah Merritt, DC
• Mineral Wells Eye Center PLLC
• Mineral Wells Isd
• Mineral Wells Medical Supply, Inc

• Internal Medicine Physician in Mineral Wells, TX
• Providers in Mineral Wells, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.