| Organization Name: | SERC OF HARRISONVILLE, L.L.C. |
| NPI Number: | 1093920639 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHERRY A PURVIS (OWNER, MANAGER, PHYSICAL THERAPIST) |
| Mailing Address: | 815 Westchester Avenue Harrisonville |
| State: | MO US |
| Postal Code: | 64701 |
| Phone Number: | 8163803344 |
| Fax Number: | 8163803044 |
| NPI Enumeration Date: | 05/14/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |