MEDICARE: SERENITY TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1104633478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	12830 E TIMBER LAKE RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67230-6501
Country	:	US
Telephone Number	:	316-209-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	12830 E TIMBER LAKE RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67230-6501
Country	:	US
Telephone Number	:	316-209-0940
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARONE J SMITH
Credential	:
Telephone Number	:	316-209-0940

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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Directions to “SERENITY TRANSPORTATION LLC ” Practice Location

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