MEDICARE: SERA PROGNOSTICS, INC

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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437582806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERA PROGNOSTICS, INC

Provider Business Mailing Address
First Line	:	2749 E PARLEYS WAY
Second Line	:	SUITE #200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1660
Country	:	US
Telephone Number	:	801-990-0772
Fax Number	:	801-990-0640

Provider Business Practice Location Address
First Line	:	2749 E PARLEYS WAY
Second Line	:	SUITE #200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1660
Country	:	US
Telephone Number	:	801-990-0772
Fax Number	:	801-990-0640

Authorized Official
Title or Position	:	SENIOR REVENUE CYCLE MANAGER
Name	:	STEPHANIE WORTHEN
Credential	:
Telephone Number	:	801-990-6600

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/25/2022

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Directions to “SERA PROGNOSTICS, INC ” Practice Location

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