Organization
SERC REHABILITATION PARTNERS LLC
Active
Other names
SERC - Saint Joseph
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY RUSSELL (MGR OF PROVIDER/PAYER ENROLLMENT)
(423) 238-8923
Entity
Organization
Contact information
Practice address
3727 GENE FIELD RD, SAINT JOSEPH, MO 64506-1806
(816) 396-8635
(816) 364-3522
Mailing address
17134 BEL RAY PL, BELTON, MO 64012-5331
(816) 226-4011
(816) 524-6115
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4370
GROUP MEDICARE PTAN
MO
Enumeration date
04/07/2014
Last updated
04/07/2014
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