| Organization Name: | SERC REBABILITATION PARTNERS, LLC |
| NPI Number: | 1083954887 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KILEY RUSSELL (MANAGER) |
| Mailing Address: | 101 W 92 Hwy Ste H Kearney |
| State: | MO US |
| Postal Code: | 640607591 |
| Phone Number: | 8169030777 |
| Fax Number: | 8169030776 |
| NPI Enumeration Date: | 02/15/2013 |
| NPI Last Update Date: | 09/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |