Organization
KELLY MEDICAL SERVICES CORPORATION LLC
Active
Other names
Kelly Medical Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDAL L DABBS M.D. (PRESIDENT)
(865) 693-1000
Entity
Organization
Contact information
Practice address
454 MCDOWELL ST, WELCH, WV 24801-2029
(304) 436-8461
Mailing address
PO BOX 634712, CINCINNATI, OH 45263-4712
(888) 203-1274
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001710014
WEST VIRGINIA BLUE SHIELD
WV
05
—
007378000
—
WV
Enumeration date
06/17/2006
Last updated
01/19/2015
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