Provider Demographics
NPI: | 1366674046 |
---|---|
Name: | SERAFINI, SISTO P (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SISTO |
Middle Name: | P |
Last Name: | SERAFINI |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | DR |
Other - First Name: | SISTO |
Other - Middle Name: | P |
Other - Last Name: | SERAFINI |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | DO |
Mailing Address - Street 1: | 8246 RIVER COUNTRY DR. |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRING HILL |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34607-2101 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-684-8637 |
Mailing Address - Fax: | 352-684-8638 |
Practice Address - Street 1: | 8246 RIVER COUNTRY DR. |
Practice Address - Street 2: | |
Practice Address - City: | SPRING HILL |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34607-2101 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-684-8637 |
Practice Address - Fax: | 352-684-8638 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-08-14 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | OS11153 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 591273247 | Other | MULTIPLAN AND PHCS |
FL | 8482165 | Other | CIGNA PPO/HMO, OPEN ACCESS AND GREATWEST |
FL | 14LS1 | Other | BCBS BLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE AND TRADITIONAL BCBS |
FL | 591273247 | Other | UHC EMPIRE PLAN |
FL | 006251800 | Medicaid | |
3996398 | Other | MAIL HANDLERS BENEFIT PLAN (MHBP) | |
FL | 9963822 | Other | AETNA, PPO, HMO, EPO, MANAGED CHOICE, MEDICARE HMO/PPO |
FL | 2447668 | Other | FIRST HEALTH, GROUP HEALTH AND COVENTRY NATIONAL NETWORK |
FL | 3465292 | Other | UHC COMMERCIAL AND MEDICARE PLANS |
FL | 357553 | Other | AVMED |
FL | 14LS1 | Other | BCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE BCBS PPO/HMO, GO BLUE |
FL | 14LS1 | Other | OUT OF STATE BLUE CROSS BLUE SHIELD |
FL | 591273247 | Other | MULTIPLAN, PHCS, PHCS SAVILITY, BEECH |
FL | 3465292 | Other | UHC COMMERCIAL AND MEDICARE PLANS |
FL | 3465292 | Other | UHC COMMERCIAL AND MEDICARE PLANS |