Organization
SERC REHABILITATION PARTNERS LLC
Active
Other names
SERC - Raytown
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY RUSSELL (MGR OF PROVIDER AND PAYER ENROLLMEN)
(423) 238-8923
Entity
Organization
Contact information
Practice address
4277 STERLING AVE, RAYTOWN, MO 64133-1351
(816) 353-0060
(816) 358-5830
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(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
MEDICARE PTAN
MO
Enumeration date
06/12/2014
Last updated
06/12/2014
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