Organization
SERC REHABILITATION PARTNERS, LLC
Active
Organization
SERC REHABILITATION PARTNERS, LLC
Active
Other names
SERC - Harrisonville
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE OPERATIONS)
(423) 238-7217
Entity
Organization
Contact information
Practice address
678 S COMMERCIAL ST, HARRISONVILLE, MO 64701
(816) 380-3325
(816) 380-3044
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4370
GROUP MEDICARE PTAN
MO
Enumeration date
06/28/2012
Last updated
02/12/2015
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