Provider Demographics
NPI:1528281540
Name:BEEVILLE MEDICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:BEEVILLE MEDICAL ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR DIVISION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-358-9200
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78364-1233
Mailing Address - Country:US
Mailing Address - Phone:361-358-9200
Mailing Address - Fax:361-362-1671
Practice Address - Street 1:801 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:GEORGE WEST
Practice Address - State:TX
Practice Address - Zip Code:78022-3866
Practice Address - Country:US
Practice Address - Phone:361-449-3405
Practice Address - Fax:361-449-3410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEEVILLE MEDICAL ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-10
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QR1300X
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095059402Medicaid
TX095059406Medicaid
TX095059407Medicaid
TX095059406Medicaid
TX673903Medicare Oscar/Certification