Healthcare Provider Details

I. General information

NPI: 1295054518
Provider Name (Legal Business Name): SERC OF CLINTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W FRANKLIN ST
CLINTON MO
64735-2007
US

IV. Provider business mailing address

109 W FRANKLIN ST
CLINTON MO
64735-2007
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-5287
  • Fax: 816-434-6632
Mailing address:
  • Phone: 816-524-5287
  • Fax: 816-434-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number105255
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number003718
License Number StateMO

VIII. Authorized Official

Name: MR. KEVIN L MCWILLIAMS
Title or Position: PRESIDENT/CLINICAL DIRECTOR
Credential: PT
Phone: 816-524-5287