Provider Demographics
NPI:1093895757
Name:PATRICK D REEVES MDPA
Entity Type:Organization
Organization Name:PATRICK D REEVES MDPA
Other - Org Name:WILSON SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-792-2104
Mailing Address - Street 1:4315 28TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410
Mailing Address - Country:US
Mailing Address - Phone:806-792-2104
Mailing Address - Fax:806-792-2134
Practice Address - Street 1:4315 28TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-792-2104
Practice Address - Fax:806-792-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007928261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159707201Medicaid
TXASC164Medicare PIN