Provider Demographics
NPI: | 1932576758 |
---|---|
Name: | SERC REHABILITATION PARTNERS LLC |
Entity Type: | Organization |
Organization Name: | SERC REHABILITATION PARTNERS LLC |
Other - Org Name: | SERC - DOUGLAS |
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: | 1741 NE DOUGLAS ST |
Practice Address - Street 2: | STE 202 |
Practice Address - City: | LEES SUMMIT |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64086-4703 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-246-2672 |
Practice Address - Fax: | 816-246-2676 |
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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |