Organization Active NPI

Serc of Kearney Inc

  • Physical Therapist
  • Kearney, MO
National Provider Identifier
1336198522
Registry record updated Feb 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2002030223 Issued in MO
Legal business name
SERC OF KEARNEY INC
Practice address
101 W 92 Hwy
Suite H
Kearney, MO 64060-7590
Phone
(816) 903-0775
Fax
(816) 903-0776
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brandi L Jackson, PT
Title
Clinic Director
Phone
(816) 903-0775

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 2002030223 MO Primary

Addresses

Primary practice location

101 W 92 Hwy
Suite H
Kearney, MO 64060-7590

Mailing address

101 W 92 Hwy
Suite H
Kearney, MO 64060-7590
Phone (816) 903-0775

Other identifiers 1

IdentifierTypeStateIssuer
37002019OtherMOBCBS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360800000000",
    "number": "1336198522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W 92 HWY",
            "address_2": "SUITE H",
            "city": "KEARNEY",
            "state": "MO",
            "postal_code": "640607590",
            "telephone_number": "816-903-0775",
            "fax_number": "816-903-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 92 HWY",
            "address_2": "SUITE H",
            "city": "KEARNEY",
            "state": "MO",
            "postal_code": "640607590",
            "telephone_number": "816-903-0775",
            "fax_number": "816-903-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERC OF KEARNEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2013-02-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "816-903-0775",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2002030223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "37002019",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.