Provider Demographics
NPI:1851505549
Name:PATRICK W WILLS MD PA
Entity Type:Organization
Organization Name:PATRICK W WILLS MD PA
Other - Org Name:INTERNAL MEDICINE & WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-739-1122
Mailing Address - Street 1:PO BOX 975418
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-5418
Mailing Address - Country:US
Mailing Address - Phone:713-739-1122
Mailing Address - Fax:713-739-1144
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-739-1122
Practice Address - Fax:713-739-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082497101Medicaid
TX00F68YMedicare PIN