Provider Demographics
NPI:1235950080
Name:SERENE HEALTH IPA
Entity type:Organization
Organization Name:SERENE HEALTH IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:V MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-259-6999
Mailing Address - Street 1:410 UNIVERSITY PKWY STE 2000
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6808
Mailing Address - Country:US
Mailing Address - Phone:706-524-7134
Mailing Address - Fax:
Practice Address - Street 1:410 UNIVERSITY PKWY STE 2000
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6808
Practice Address - Country:US
Practice Address - Phone:706-524-7134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty