MEDICARE: SERVE ALL MEDICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1477148260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVE ALL MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	HOLLAND
State	:	TX
Zip	:	76534-0339
Country	:	US
Telephone Number	:	512-487-5556
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 S INTERSTATE 35 STE 260
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3290
Country	:	US
Telephone Number	:	512-487-5556
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MARKETING OFFICER
Name	:	JONATHON INGRAM
Credential	:
Telephone Number	:	832-350-1778

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	06/23/2022

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