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?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty