Healthcare Provider Details

I. General information

NPI: 1568816965
Provider Name (Legal Business Name): SERENAGROUP PROFESSIONAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 08/20/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

PO BOX 791
CARNEGIE PA
15106-0791
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-5760
  • Fax:
Mailing address:
  • Phone: 412-655-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number228580
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BLAIR FLINN
Title or Position: VP OF PROFESSIONAL SERVICES
Credential: MHA
Phone: 913-426-4995