Provider Demographics
NPI:1992819601
Name:SERENDIPITY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:SERENDIPITY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-324-1230
Mailing Address - Street 1:PO BOX 58866
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8866
Mailing Address - Country:US
Mailing Address - Phone:281-338-4000
Mailing Address - Fax:281-324-6155
Practice Address - Street 1:2171 SILVER MOON TRL
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-3503
Practice Address - Country:US
Practice Address - Phone:281-338-4000
Practice Address - Fax:281-324-1230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENDIPITY MEDICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1493447-01Medicaid
TX00996RMedicare PIN