Provider Demographics
NPI:1093390270
Name:SERVE ALL MEDICAL TYLER, PLLC
Entity Type:Organization
Organization Name:SERVE ALL MEDICAL TYLER, PLLC
Other - Org Name:CLINICA HISPANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MARKETING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-350-1778
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76534-0339
Mailing Address - Country:US
Mailing Address - Phone:512-487-5556
Mailing Address - Fax:
Practice Address - Street 1:510 S SOUTHWEST LOOP 323 STE 140
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7687
Practice Address - Country:US
Practice Address - Phone:903-530-0240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty