Healthcare Provider Details

I. General information

NPI: 1497156236
Provider Name (Legal Business Name): SERODYNAMICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 TEJON ST SUITE 101
DENVER CO
80211-1259
US

IV. Provider business mailing address

4785 TEJON ST SUITE 101
DENVER CO
80211-1259
US

V. Phone/Fax

Practice location:
  • Phone: 303-990-5912
  • Fax: 855-928-0101
Mailing address:
  • Phone: 303-990-5912
  • Fax: 855-928-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number06D2082846
License Number StateCO

VIII. Authorized Official

Name: BEAU GERTZ
Title or Position: CO-FOUNDER / PRESIDENT OF SALES
Credential:
Phone: 303-877-8789