Provider Demographics
NPI:1669850541
Name:SERENITY SURGICAL SERVICES SC
Entity Type:Organization
Organization Name:SERENITY SURGICAL SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMON
Authorized Official - Middle Name:
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:III
Authorized Official - Credentials:CSA
Authorized Official - Phone:312-925-3260
Mailing Address - Street 1:PO BOX 26975
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-6975
Mailing Address - Country:US
Mailing Address - Phone:904-503-1132
Mailing Address - Fax:888-886-4464
Practice Address - Street 1:8830 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1514
Practice Address - Country:US
Practice Address - Phone:312-925-3260
Practice Address - Fax:888-886-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty