Organization Active NPI

Serenity Wellness Center

  • Psychiatry Physician
  • Norman, OK
National Provider Identifier
1093094310
Registry record updated Sep 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
24708 Issued in OK
Legal business name
SERENITY WELLNESS CENTER
Practice address
3750 W Main St Ste Aa
Norman, OK 73072-4645
Phone
(405) 790-0500
Fax
(405) 790-0501
NPI assigned
Aug 4, 2011
Last updated
Sep 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Benjamin Quiambao, MDNPI 1770796336
Title
Psychiatrist
Phone
(405) 790-0500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 24708 OK Primary
Child & Adolescent Psychiatry Physician 2084P0804X NU

Addresses

Primary practice location

3750 W Main St Ste Aa
Norman, OK 73072-4645

Mailing address

PO Box 6708
Moore, OK 73153-0708
Phone (405) 790-0500

Other identifiers 1

IdentifierTypeStateIssuer
200238960AMedicaidOK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727481600000",
    "number": "1093094310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6708",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731530708",
            "telephone_number": "405-790-0500",
            "fax_number": "405-790-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 W MAIN ST STE AA",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730724645",
            "telephone_number": "405-790-0500",
            "fax_number": "405-790-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-04",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A",
        "authorized_official_last_name": "QUIAMBAO",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "405-790-0500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "24708",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200238960A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.