Provider Demographics
NPI:1184024408
Name:SERAFINI MEDICAL, P.C.
Entity Type:Organization
Organization Name:SERAFINI MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./D.O./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GHAISON
Authorized Official - Middle Name:F
Authorized Official - Last Name:SERAFINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-224-3155
Mailing Address - Street 1:1509 NW MOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3096
Mailing Address - Country:US
Mailing Address - Phone:816-224-3155
Mailing Address - Fax:816-224-3185
Practice Address - Street 1:1509 NW MOCK AVE
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3096
Practice Address - Country:US
Practice Address - Phone:816-224-3155
Practice Address - Fax:816-224-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013035498207N00000X, 207Q00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA5221001OtherMEDICARE PTAN - GROUP
MOMA5221OtherMEDICARE PTAN - INDIVIDUAL
MO26D2079913OtherCLIA