Provider Demographics
NPI:1508080672
Name:BEEVILLE MEDICAL ASSOCIATES - LA BAHIA THSTEPS
Entity Type:Organization
Organization Name:BEEVILLE MEDICAL ASSOCIATES - LA BAHIA THSTEPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:
Practice Address - Street 1:1600 E HOUSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5313
Practice Address - Country:US
Practice Address - Phone:361-358-9200
Practice Address - Fax:361-358-9210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEEVILLE MEDCIAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 207RI0200X, 207RN0300X, 207RP1001X, 208000000X, 208D00000X, 213E00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095059405Medicaid