NPIMap

Organization Active NPI

Serc Rehabilitation Partners LLC

  • Physical Therapy Clinic/Center
  • Raytown, MO
National Provider Identifier
1982018412
Registry record updated Jun 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SERC REHABILITATION PARTNERS LLC
Practice address
4277 Sterling Ave
Raytown, MO 64133-1351
Phone
(816) 353-0060
Fax
(816) 358-5830
NPI assigned
Jun 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2014

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

Authorized official

Name
Kiley Russell
Title
MGR of Provider and Payer Enrollmen
Phone
(423) 238-8923

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

4277 Sterling Ave
Raytown, MO 64133-1351

Mailing address

8823 Production LN
Ooltewah, TN 37363-6511
Phone (816) 226-4011

Other identifiers 1

IdentifierTypeStateIssuer
MA4370OtherMOMEDICARE PTAN

Other names 1

  • SERC - Raytown Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Serc Rebabilitation Partners LLC82 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1982018412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "816-226-4011",
            "fax_number": "816-524-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4277 STERLING AVE",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641331351",
            "telephone_number": "816-353-0060",
            "fax_number": "816-358-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERC REHABILITATION PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-12",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "KILEY",
        "authorized_official_title_or_position": "MGR OF PROVIDER AND PAYER ENROLLMEN",
        "authorized_official_telephone_number": "423-238-8923"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MA4370",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SERC - Raytown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raytown, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; 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.