Provider Demographics
NPI:1356762447
Name:SERENITY SURGERY
Entity type:Organization
Organization Name:SERENITY SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:HANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:618-288-2052
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-0527
Mailing Address - Country:US
Mailing Address - Phone:618-288-2052
Mailing Address - Fax:
Practice Address - Street 1:2227 VADALABENE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5823
Practice Address - Country:US
Practice Address - Phone:618-288-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty