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General NPI Number Information
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NPI Number | 1841592821
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Entity Type | Organization
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Legal Business Name | WELLSPRING FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 07/31/2011
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Provider Practice Location Address
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Address Line | 800 W HIGHWAY 290 BLDG A STE 100
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-4004
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Country | US
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Telephone | 512-858-4100
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Fax | 512-858-4223
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Provider Business Mailing Address
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Address Line | 800 W HIGHWAY 290 BLDG A STE 100
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-4004
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Country | US
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Telephone | 512-858-4100
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Fax | 512-858-4223
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Authorized Official
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Title or Position | PRINCIPAL MANAGER
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Name | DR. GRACE L HONLES
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Credential | MD
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Telephone | 512-858-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L0273
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License Number State | TX
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