Organization
KELLY MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK STEVEN KELLY (OWNER)
(910) 458-7799
Entity
Organization
Contact information
Practice address
1204 N LAKE PARK BLVD, UNIT F., CAROLINA BEACH, NC 28428-4163
(910) 458-7799
(910) 458-5325
Mailing address
1204 N LAKE PARK BLVD, UNIT F., CAROLINA BEACH, NC 28428-4163
(910) 458-7799
(910) 458-5325
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
3418849
NC
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
01533
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418849
—
NC
05
—
7705155
—
NC
Enumeration date
08/03/2009
Last updated
11/04/2010
Update your record
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