Provider Demographics
NPI:1497076061
Name:J&S KELLY GALESBURG, LLC
Entity Type:Organization
Organization Name:J&S KELLY GALESBURG, LLC
Other - Org Name:KELLY'S MEDICAL EQUIPMENT & SUPPLY OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-386-1553
Mailing Address - Street 1:730 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1621
Mailing Address - Country:US
Mailing Address - Phone:563-386-1553
Mailing Address - Fax:563-449-5450
Practice Address - Street 1:765 N KELLOGG ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2875
Practice Address - Country:US
Practice Address - Phone:563-386-1553
Practice Address - Fax:563-449-5450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J&S KELLY GALESBURG LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-18
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies