Provider Demographics
NPI:1689079899
Name:SERC REHABILITATION PARTNERS LLC
Entity Type:Organization
Organization Name:SERC REHABILITATION PARTNERS LLC
Other - Org Name:SERC - ROGERS
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 1:2603 W PLEASANT GROVE RD
Practice Address - Street 2:STE 104
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8514
Practice Address - Country:US
Practice Address - Phone:816-226-4011
Practice Address - Fax:816-524-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy