Provider Demographics
NPI:1598813255
Name:KERRY'S MEDICAL INC
Entity Type:Organization
Organization Name:KERRY'S MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:MILBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-374-0400
Mailing Address - Street 1:2204 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2425
Mailing Address - Country:US
Mailing Address - Phone:916-374-0400
Mailing Address - Fax:916-374-0404
Practice Address - Street 1:2204 W CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2425
Practice Address - Country:US
Practice Address - Phone:916-374-0400
Practice Address - Fax:916-374-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5338480001Medicare NSC