Provider Demographics
NPI:1881833218
Name:BEEVILLE INTERNISTS, PLLC
Entity Type:Organization
Organization Name:BEEVILLE INTERNISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHRAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-343-2258
Mailing Address - Street 1:PO BOX 3808
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3808
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:
Practice Address - Street 1:711 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5023
Practice Address - Country:US
Practice Address - Phone:361-343-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2669207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179720107Medicaid
TXM2669OtherPHYSICIAN PERMIT
TX204852202Medicaid
TXM2669OtherPHYSICIAN PERMIT
TX0A4672Medicare PIN