Healthcare Provider Details

I. General information

NPI: 1639502693
Provider Name (Legal Business Name): SERC REHABILITATION PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14802 SHAMROCK WAY STE C
SMITHVILLE MO
64089-8381
US

IV. Provider business mailing address

17134 BEL RAY PL
BELTON MO
64012-5331
US

V. Phone/Fax

Practice location:
  • Phone: 816-873-1100
  • Fax: 816-399-5796
Mailing address:
  • Phone: 816-318-0436
  • Fax: 816-318-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KILEY RUSSELL
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 423-238-7217