Provider Demographics
NPI:1841592821
Name:WELLSPRING FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:WELLSPRING FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HONLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-858-4100
Mailing Address - Street 1:800 W HIGHWAY 290 BLDG A
Mailing Address - Street 2:STE 100
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4004
Mailing Address - Country:US
Mailing Address - Phone:512-858-4100
Mailing Address - Fax:512-858-4223
Practice Address - Street 1:800 W HIGHWAY 290 BLDG A
Practice Address - Street 2:STE 100
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4004
Practice Address - Country:US
Practice Address - Phone:512-858-4100
Practice Address - Fax:512-858-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty