Provider Demographics
NPI:1669538252
Name:SERVE INC
Entity type:Organization
Organization Name:SERVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:573-642-6388
Mailing Address - Street 1:4901 CO RD 304
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251
Mailing Address - Country:US
Mailing Address - Phone:573-642-6388
Mailing Address - Fax:573-642-2191
Practice Address - Street 1:4901 CO RD 304
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-642-6388
Practice Address - Fax:573-642-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5073430Medicaid