Provider Demographics
NPI:1457667354
Name:SERENITY NETWORK OF CARE, PLLC
Entity Type:Organization
Organization Name:SERENITY NETWORK OF CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:325-716-8226
Mailing Address - Street 1:2222 FAWN MIST LN STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1907
Mailing Address - Country:US
Mailing Address - Phone:210-872-5530
Mailing Address - Fax:320-210-8156
Practice Address - Street 1:2222 FAWN MIST LN STE 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1907
Practice Address - Country:US
Practice Address - Phone:210-872-5530
Practice Address - Fax:320-210-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC12349Medicare UPIN