{
"Npi": {
"NPI": "1366592966",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KERRY'S MEDICAL INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2204 W CAPITOL AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "W SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95691-2425",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-374-0400",
"MailingAddressFaxNumber": "916-374-0404",
"FirstLinePracticeLocationAddress": "3615 S RAINBOW BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89103-1057",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-579-9050",
"PracticeLocationAddressFaxNumber": "702-579-9051",
"EnumerationDate": "01/12/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILBERGER",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": "LANE",
"AuthorizedOfficialTitle": "VICE PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-374-0400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}