Healthcare Provider Details

I. General information

NPI: 1366592966
Provider Name (Legal Business Name): KERRY'S MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 S RAINBOW BLVD
LAS VEGAS NV
89103-1057
US

IV. Provider business mailing address

2204 W CAPITOL AVE
W SACRAMENTO CA
95691-2425
US

V. Phone/Fax

Practice location:
  • Phone: 702-579-9050
  • Fax: 702-579-9051
Mailing address:
  • Phone: 916-374-0400
  • Fax: 916-374-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY LANE MILBERGER
Title or Position: VICE PRESIDENT
Credential:
Phone: 916-374-0400