Provider Demographics
NPI:1790903029
Name:M E KERRIGAN INC
Entity Type:Organization
Organization Name:M E KERRIGAN INC
Other - Org Name:HEALTHSCREEN OF OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-949-8066
Mailing Address - Street 1:3937 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-1009
Mailing Address - Country:US
Mailing Address - Phone:440-949-8066
Mailing Address - Fax:440-949-4894
Practice Address - Street 1:3937 E LAKE RD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD LAKE
Practice Address - State:OH
Practice Address - Zip Code:44054-1009
Practice Address - Country:US
Practice Address - Phone:440-949-8066
Practice Address - Fax:440-949-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFV93261Medicare PIN