Provider Demographics
NPI:1669778304
Name:WELLMED MEDICAL GROUP, PA
Entity type:Organization
Organization Name:WELLMED MEDICAL GROUP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR LICENSE&REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYIRI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-850-6272
Mailing Address - Street 1:19500 IH 10 W
Mailing Address - Street 2:MS 1-5030 ATTN: LICENSE & REGULATORY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-9509
Mailing Address - Country:US
Mailing Address - Phone:210-617-4706
Mailing Address - Fax:
Practice Address - Street 1:4700 W SAM HOUSTON PKWY N STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-8224
Practice Address - Country:US
Practice Address - Phone:210-850-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty