Provider Demographics
NPI:1073987053
Name:SERENITY SURGICAL, LLC
Entity Type:Organization
Organization Name:SERENITY SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-513-9582
Mailing Address - Street 1:8840 CALUMET AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2545
Mailing Address - Country:US
Mailing Address - Phone:219-513-9582
Mailing Address - Fax:219-513-8515
Practice Address - Street 1:8840 CALUMET AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2545
Practice Address - Country:US
Practice Address - Phone:219-513-9582
Practice Address - Fax:219-513-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16-013584-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical