MEDICARE: KERRY'S MEDICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1366592966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERRY'S MEDICAL INC

Provider Business Mailing Address
First Line	:	2204 W CAPITOL AVE
Second Line	:
City	:	W SACRAMENTO
State	:	CA
Zip	:	95691-2425
Country	:	US
Telephone Number	:	916-374-0400
Fax Number	:	916-374-0404

Provider Business Practice Location Address
First Line	:	3615 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1057
Country	:	US
Telephone Number	:	702-579-9050
Fax Number	:	702-579-9051

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. TIMOTHY LANE MILBERGER
Credential	:
Telephone Number	:	916-374-0400

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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