Healthcare Provider Details

I. General information

NPI: 1669850541
Provider Name (Legal Business Name): SERENITY SURGICAL SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 S ROBERTS RD
HICKORY HILLS IL
60457-1514
US

IV. Provider business mailing address

PO BOX 26975
JACKSONVILLE FL
32226-6975
US

V. Phone/Fax

Practice location:
  • Phone: 312-925-3260
  • Fax: 888-886-4464
Mailing address:
  • Phone: 904-503-1132
  • Fax: 888-886-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. HERMON TONEY III
Title or Position: CEO
Credential: CSA
Phone: 312-925-3260