Provider Demographics
NPI:1306896295
Name:KERLEY MEDICAL EQUIPMENT & SUPPLY, INC.
Entity type:Organization
Organization Name:KERLEY MEDICAL EQUIPMENT & SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CERT PEDORTHI
Authorized Official - Phone:256-519-2386
Mailing Address - Street 1:4851 WHITESBURG DR SE STE D2
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1654
Mailing Address - Country:US
Mailing Address - Phone:256-519-2386
Mailing Address - Fax:256-533-6334
Practice Address - Street 1:4851 WHITESBURG DR SE STE D2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1654
Practice Address - Country:US
Practice Address - Phone:256-519-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AL168332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936130Medicaid
AL51078615OtherBLUE CROSS BLUE SHIELD AL