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General NPI Number Information
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NPI Number | 1265023543
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Entity Type | Organization
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Legal Business Name | KERECIS LLC
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 2300 CLARENDON BLVD STE 1210
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City | ARLINGTON
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State | VA
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Zip | 22201-3300
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Country | US
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Telephone | 703-328-9091
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Fax | 703-287-8752
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Provider Business Mailing Address
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Address Line | 2300 CLARENDON BLVD STE 1210
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City | ARLINGTON
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State | VA
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Zip | 22201-3300
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Country | US
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Telephone | 703-328-9091
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. JOSEPH SMITH
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Credential |
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Telephone | 703-287-8752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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