Organization Active NPI

Serve All Medical Miller, PLLC

Doing business as Clinica Hispana

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1740865922
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SERVE ALL MEDICAL MILLER, PLLC
Doing business as
Clinica Hispana
Practice address
3305 Miller Ave
Fort Worth, TX 76119-1956
Phone
(682) 253-8204
NPI assigned
Mar 10, 2021
Last updated
Jun 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jonathon Ingram
Title
Chief Marketing Officer
Phone
(832) 350-1778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

3305 Miller Ave
Fort Worth, TX 76119-1956

Mailing address

PO Box 339
Holland, TX 76534-0339
Phone (512) 487-5556

Other names 1

  • Clinica Hispana Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2248157Serve All Medical Miller, PLLC3305 Miller Ave Suite B, Fort Worth, TX 76119Certificate of waiverJan 11, 2028

National Provider Directory

National Provider Directory

Locations

3305 Miller Ave
Fort Worth, TX 76119
Phone (682) 253-8204

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1740865922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 339",
            "city": "HOLLAND",
            "state": "TX",
            "postal_code": "765340339",
            "telephone_number": "512-487-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 MILLER AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761191956",
            "telephone_number": "682-253-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERVE ALL MEDICAL MILLER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-10",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_title_or_position": "CHIEF MARKETING OFFICER",
        "authorized_official_telephone_number": "832-350-1778"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinica Hispana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.