Provider Demographics
NPI:1588146583
Name:KESSLICK MEDICAL CORPORATION
Entity type:Organization
Organization Name:KESSLICK MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KESSLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-842-8266
Mailing Address - Street 1:870 MCCLELLANDTOWN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANDTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15458-1253
Mailing Address - Country:US
Mailing Address - Phone:724-892-2566
Mailing Address - Fax:
Practice Address - Street 1:870 MCCLELLANDTOWN RD STE 4
Practice Address - Street 2:
Practice Address - City:MC CLELLANDTOWN
Practice Address - State:PA
Practice Address - Zip Code:15458-1253
Practice Address - Country:US
Practice Address - Phone:724-892-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies