Provider Demographics
NPI:1841407178
Name:SERC OF KEARNEY, INC.
Entity Type:Organization
Organization Name:SERC OF KEARNEY, INC.
Other - Org Name:SERC OF KEARNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:816-903-0775
Mailing Address - Street 1:105 S JEFFERSON ST
Mailing Address - Street 2:SUITE B5
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8503
Mailing Address - Country:US
Mailing Address - Phone:816-903-0775
Mailing Address - Fax:815-903-0776
Practice Address - Street 1:105 S JEFFERSON ST
Practice Address - Street 2:SUITE B5
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8503
Practice Address - Country:US
Practice Address - Phone:816-903-0775
Practice Address - Fax:815-903-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOW120000Medicare ID - Type UnspecifiedKEARNEY MEDICARE