MEDICARE: SERC OF LEE'S SUMMIT

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)		MO

General Provider Information

NPI Number	:	1306053632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERC OF LEE'S SUMMIT

Provider Business Mailing Address
First Line	:	3500 SW MARKET ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-2327
Country	:	US
Telephone Number	:	816-537-5650
Fax Number	:	816-537-5649

Provider Business Practice Location Address
First Line	:	3500 SW MARKET ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-2327
Country	:	US
Telephone Number	:	816-537-5650
Fax Number	:	816-537-5649

Authorized Official
Title or Position	:	OWNER, MANAGER, PHYSICAL THERAPIST
Name	:	MARK A WERNSMAN
Credential	:	MPT
Telephone Number	:	816-537-5650

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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Directions to “SERC OF LEE'S SUMMIT ” Practice Location

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