Provider Demographics
NPI:1720230188
Name:CONNAUGHT MEDICAL PRACTICE PLLC
Entity Type:Organization
Organization Name:CONNAUGHT MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-826-2226
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:79096-0130
Mailing Address - Country:US
Mailing Address - Phone:806-826-2226
Mailing Address - Fax:806-826-2282
Practice Address - Street 1:307 EAST NINTH ST
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:TX
Practice Address - Zip Code:79096-0296
Practice Address - Country:US
Practice Address - Phone:806-826-2226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4024261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB08182Medicare UPIN