Provider Demographics
NPI:1881796142
Name:MCCREARY MEDICAL RESOURCES, LLC
Entity type:Organization
Organization Name:MCCREARY MEDICAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-376-1551
Mailing Address - Street 1:PO BOX 1180
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-1180
Mailing Address - Country:US
Mailing Address - Phone:606-376-1551
Mailing Address - Fax:606-376-1502
Practice Address - Street 1:57 OAKS LN
Practice Address - Street 2:SUITE 14
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653
Practice Address - Country:US
Practice Address - Phone:606-376-1551
Practice Address - Fax:606-376-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2007-12-13
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
KY90006750Medicaid
KY000000331701OtherANTHEM BCBS
KY45002458Medicaid
KY4829240001Medicare ID - Type Unspecified