Organization
MCCREARY MEDICAL RESOURCES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY L PENNINGTON (OWNER)
(606) 376-1551
Entity
Organization
Contact information
Practice address
57 OAKS LN, SUITE 14, WHITLEY CITY, KY 42653
(606) 376-1551
(606) 376-1502
Mailing address
PO BOX 1180, WHITLEY CITY, KY 42653-1180
(606) 376-1551
(606) 376-1502
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000331701
ANTHEM BCBS
KY
05
—
45002458
—
KY
05
—
90006750
—
KY
Enumeration date
09/05/2006
Last updated
12/13/2007
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