Provider Demographics
NPI:1801621131
Name:SERVE MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:SERVE MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:903-315-0774
Mailing Address - Street 1:6054 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-7586
Mailing Address - Country:US
Mailing Address - Phone:903-315-0774
Mailing Address - Fax:
Practice Address - Street 1:6054 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75645-7586
Practice Address - Country:US
Practice Address - Phone:903-315-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies