MEDICARE: SERIO MISSOURI 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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1467633834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERIO MISSOURI LLC

Provider Business Mailing Address
First Line	:	1241 W MINERAL AVE
Second Line	:	SUITE 100
City	:	LITTLETON
State	:	CO
Zip	:	80120-5685
Country	:	US
Telephone Number	:	303-759-0854
Fax Number	:	303-759-0864

Provider Business Practice Location Address
First Line	:	10010 KENNERLY RD
Second Line	:	ST. ANTHONY'S MEDICAL CENTER
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1900
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	ROSE AREBALO
Credential	:
Telephone Number	:	303-759-0854

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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