Healthcare Provider Details

I. General information

NPI: 1104267574
Provider Name (Legal Business Name): TWIN FOUNTAINS PRIMARY CARE CLINIC OF BEEVILLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 E HOUSTON ST SUITE C
BEEVILLE TX
78102-5326
US

IV. Provider business mailing address

1908 N LAURENT ST SUITE 550
VICTORIA TX
77901-5468
US

V. Phone/Fax

Practice location:
  • Phone: 361-358-9200
  • Fax: 361-362-1671
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-572-8518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN L MCNEILL
Title or Position: OWNER
Credential: MD
Phone: 361-578-5730