Basic Information
| Provider Information | |||||||||
| NPI: | 1336683200 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SERC REHABILITATION PARTNERS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SERC - CENTERTON | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232387217 | ||||||||
| FaxNumber: | 4232383473 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 E CENTERTON BLVD | ||||||||
| Address2: | |||||||||
| City: | CENTERTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727191300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797950173 | ||||||||
| FaxNumber: | 4797950467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2016 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | BARGANIER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2055367602 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | AR | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QX0100X | AR | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 261QP2000X | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.