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General NPI Number Information
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NPI Number | 1356762447
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Entity Type | Organization
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Legal Business Name | SERENITY SURGERY
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 2227 VADALABENE DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5823
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Country | US
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Telephone | 618-288-2052
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 527
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City | MARYVILLE
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State | IL
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Zip | 62062-0527
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Country | US
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Telephone | 618-288-2052
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Fax |
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Authorized Official
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Title or Position | D.O.
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Name | HANIA BEDNARSKI
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Credential | D.O.
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Telephone | 618-288-2052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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