Healthcare Provider Details

I. General information

NPI: 1396009833
Provider Name (Legal Business Name): SERC REHABILITATION PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N 2ND ST
ODESSA MO
64076-1135
US

IV. Provider business mailing address

17134 BEL RAY PL
BELTON MO
64012-5331
US

V. Phone/Fax

Practice location:
  • Phone: 816-230-3280
  • Fax: 816-230-3230
Mailing address:
  • Phone: 816-524-5130
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KILEY RUSSELL
Title or Position: MANAGER
Credential:
Phone: 423-238-8923