| Clinica Hispana | |
|
510 S Southwest Loop 323 Ste 140 Tyler TX 75702-7687 | |
| (903) 530-0240 | |
| Not Available |
| Full Name | Clinica Hispana |
|---|---|
| Speciality | Internal Medicine |
| Location | 510 S Southwest Loop 323 Ste 140, Tyler, Texas |
| Authorized Official Name and Position | Jonathon Ingram (CHIEF MARKETING OFFICER) |
| Authorized Official Contact | 8323501778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Hispana Po Box 339 Holland TX 76534-0339 Ph: (512) 487-5556 | Clinica Hispana 510 S Southwest Loop 323 Ste 140 Tyler TX 75702-7687 Ph: (903) 530-0240 |
| NPI Number | 1093390270 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 06/23/2022 |
| Medicare PECOS PAC ID | 2062886476 |
|---|---|
| Medicare Enrollment ID | O20230327002212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093390270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Joshua Aaron Allen |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1699760264 PECOS PAC ID: 2062483282 Enrollment ID: I20040803000146 |
| Provider Name | Timothy Joe Hillbrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205835451 PECOS PAC ID: 0749214765 Enrollment ID: I20150604000473 |
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