Organization
SERC HAND NORTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN R LARSON OTR/L, CHT (CLINIC MANAGER)
(816) 792-0775
Entity
Organization
Contact information
Practice address
1512 NE 96TH ST, LIBERTY, MO 64068-7174
(816) 792-0775
(816) 792-0776
Mailing address
1512 NE 96TH ST, LIBERTY, MO 64068-7174
(816) 792-0775
(816) 792-0776
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
004600
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39684012
BCBS OF KC
MO
Enumeration date
06/17/2009
Last updated
06/17/2009
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