Provider Demographics
NPI:1023211372
Name:SERRANO FAMILY PRACTICE
Entity Type:Organization
Organization Name:SERRANO FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-833-5520
Mailing Address - Street 1:P.O. BOX 457
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147
Mailing Address - Country:US
Mailing Address - Phone:614-833-5520
Mailing Address - Fax:614-833-5525
Practice Address - Street 1:475 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1157
Practice Address - Country:US
Practice Address - Phone:614-833-5520
Practice Address - Fax:614-833-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2343002Medicaid
OH9325561Medicare ID - Type Unspecified