Basic Information
| Provider Information | |||||||||
| NPI: | 1396320578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERVE ALL MEDICAL JACKSONVILLE, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CLINICA HISPANA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 339 | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765340339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124875556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1009 S JACKSON ST STE 325 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757663057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032474877 | ||||||||
| FaxNumber: | 8323081272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2021 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | INGRAM | ||||||||
| AuthorizedOfficialFirstName: | JONATHON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MARKETING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8323501778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.