Provider Demographics
NPI:1013384833
Name:SERC REHABILITATION PARTNERS LLC
Entity Type:Organization
Organization Name:SERC REHABILITATION PARTNERS LLC
Other - Org Name:SERC - WEBB CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-238-7217
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:501 S MADISON ST
Practice Address - Street 2:STE L
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2502
Practice Address - Country:US
Practice Address - Phone:417-673-2157
Practice Address - Fax:417-673-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy