Provider Demographics
NPI:1659396364
Name:J & S KELLY LLC
Entity Type:Organization
Organization Name:J & S KELLY LLC
Other - Org Name:KELLY'S MEDICAL EQUIPMENT & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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:563-391-7702
Practice Address - Street 1:931 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5032
Practice Address - Country:US
Practice Address - Phone:563-242-2305
Practice Address - Fax:563-242-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002 1Medicaid
IA1254070003Medicare NSC