Provider Demographics
NPI:1699357632
Name:SERVE ALL MEDICAL GRAND PRAIRIE, PLLC
Entity Type:Organization
Organization Name:SERVE ALL MEDICAL GRAND PRAIRIE, PLLC
Other - Org Name:CLINICA HISPANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-864-5656
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 1:513 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1606
Practice Address - Country:US
Practice Address - Phone:469-213-8421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty