Provider Demographics
NPI: | 1508638628 |
---|---|
Name: | SERENITY DIAGNOSTIC SERVICES LLC |
Entity Type: | Organization |
Organization Name: | SERENITY DIAGNOSTIC SERVICES LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRADLEY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CUBITT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 817-658-5106 |
Mailing Address - Street 1: | 1211 VIRIDIAN PARK LN |
Mailing Address - Street 2: | |
Mailing Address - City: | ARLINGTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76005-1117 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-658-5106 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1211 VIRIDIAN PARK LN |
Practice Address - Street 2: | |
Practice Address - City: | ARLINGTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76005-1117 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-658-5106 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-10-23 |
Last Update Date: | 2023-10-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 246ZE0600X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic | Group - Single Specialty |