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General NPI Number Information
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NPI Number | 1497156236
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Entity Type | Organization
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Legal Business Name | SERODYNAMICS, LLC
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 4785 TEJON ST SUITE 101
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City | DENVER
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State | CO
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Zip | 80211-1259
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Country | US
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Telephone | 303-990-5912
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Fax | 855-928-0101
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Provider Business Mailing Address
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Address Line | 4785 TEJON ST SUITE 101
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City | DENVER
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State | CO
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Zip | 80211-1259
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Country | US
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Telephone | 303-990-5912
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Fax | 855-928-0101
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Authorized Official
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Title or Position | CO-FOUNDER / PRESIDENT OF SALES
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Name | BEAU GERTZ
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Credential |
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Telephone | 303-877-8789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 06D2082846
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License Number State | CO
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