1013225622 NPI number — KERLEY MEDICAL EQUIPMENT & SUPPLY, INC.

Table of content: (NPI 1013225622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013225622 NPI number — KERLEY MEDICAL EQUIPMENT & SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERLEY MEDICAL EQUIPMENT & SUPPLY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013225622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 SIVLEY RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-5105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-327-5710
Provider Business Mailing Address Fax Number:
256-327-5718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 CCI DR NW
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35805-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-327-5710
Provider Business Practice Location Address Fax Number:
256-327-5718
Provider Enumeration Date:
09/16/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KERLEY
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-327-5710

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ALLIED FOR , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".