Provider Demographics
NPI:1043601487
Name:SERRANO MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:SERRANO MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:PANGANIBAN
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-303-3396
Mailing Address - Street 1:100 W PIONEER PKWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6131
Mailing Address - Country:US
Mailing Address - Phone:817-303-3396
Mailing Address - Fax:
Practice Address - Street 1:100 W PIONEER PKWY
Practice Address - Street 2:SUITE 114
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6131
Practice Address - Country:US
Practice Address - Phone:817-303-3396
Practice Address - Fax:817-275-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1988261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB26357Medicare UPIN