Serenity Creek Med Spa

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

Legal business name

SERENITY CREEK MED SPA

Practice address

8900 Shoal Creek Blvd
Building 300-a
Austin, TX 78757-6810

Phone

(512) 375-3858

Fax

(512) 375-3865

NPI assigned

Jul 29, 2014

Last updated

Jul 30, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nathalie Blackstock

Title

Executive Director, RCM Division

Phone

(512) 323-6900

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406678400000",
    "number": "1972911436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8900 SHOAL CREEK BLVD",
            "address_2": "BUILDING 300-A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787576810",
            "telephone_number": "512-375-3858",
            "fax_number": "512-375-3865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8900 SHOAL CREEK BLVD",
            "address_2": "BUILDING 300-A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787576810",
            "telephone_number": "512-375-3858",
            "fax_number": "512-375-3865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY CREEK MED SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-29",
        "last_updated": "2014-07-30",
        "status": "A",
        "authorized_official_last_name": "BLACKSTOCK",
        "authorized_official_first_name": "NATHALIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, RCM DIVISION",
        "authorized_official_telephone_number": "512-323-6900"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Allergy & Immunology Physician in Austin, TX
• Providers in Austin, TX by specialty
• Allergy & Immunology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; 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.