MEDICARE: SERC HAND NORTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	004600	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39684012	OTHER	MO	BCBS OF KC

General Provider Information

NPI Number	:	1225269418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERC HAND NORTH INC

Provider Business Mailing Address
First Line	:	8409 N MAIN ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2426
Country	:	US
Telephone Number	:	816-420-0286
Fax Number	:	816-420-8207

Provider Business Practice Location Address
First Line	:	8409 N MAIN ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2426
Country	:	US
Telephone Number	:	816-420-0286
Fax Number	:	816-420-8207

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	KRISTEN R LARSON
Credential	:	OTR/L, CHT
Telephone Number	:	816-420-0286

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	08/05/2009

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