Organization
SERC REHABILITATION PARTNERS LLC
Active
Other names
SERC - Grain Valley
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE OPERATIONS)
(423) 238-7217
Entity
Organization
Contact information
Practice address
103 SW EAGLES PKWY, GRAIN VALLEY, MO 64029-8512
(816) 443-2375
(816) 443-2380
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4370
MEDICARE PTAN
MO
Enumeration date
10/17/2014
Last updated
10/17/2014
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