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NPI Code Detail

MEDICARE: SERENITY DIAGNOSTIC SERVICES LLC

MEDICARE: SERENITY DIAGNOSTIC SERVICES 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
1246ZE0600XElectroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number : 1508638628
Entity Type Code : Organization
Provider Name (Legal Business Name) : SERENITY DIAGNOSTIC SERVICES LLC
Provider Business Mailing Address
First Line : 1211 VIRIDIAN PARK LN
Second Line :
City : ARLINGTON
State : TX
Zip : 76005-1117
Country : US
Telephone Number : 817-658-5106
Fax Number :
Provider Business Practice Location Address
First Line : 1211 VIRIDIAN PARK LN
Second Line :
City : ARLINGTON
State : TX
Zip : 76005-1117
Country : US
Telephone Number : 817-658-5106
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BRADLEY CUBITT
Credential : MD
Telephone Number : 817-658-5106
Provider Enumeration Date : 10/23/2023
Last Update Date : 10/23/2023

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Directions to “SERENITY DIAGNOSTIC SERVICES LLC ” Practice Location

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