Kelly Medical Services, S.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

24545 Issued in WI

Legal business name

KELLY MEDICAL SERVICES, S.C.

Practice address

820 E. Summit Ave.
Oconomowoc, WI 53066

Phone

(262) 567-6927

Fax

(262) 567-8003

NPI assigned

Oct 2, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John E. Kelly, M.D.

Title

President

Phone

(262) 567-6927

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740374230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E. SUMMIT AVE.",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "53066",
            "telephone_number": "262-567-6927",
            "fax_number": "262-567-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E. SUMMIT AVE.",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "53066",
            "telephone_number": "262-567-6927",
            "fax_number": "262-567-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY MEDICAL SERVICES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-567-6927",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WI",
            "license": "24545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30453000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine a. Knabe, LLC
• Kourtney Kaufman, COTA/L
• Tyese Kazee
• Rebecca Ann Keller, MPT
• Patricia R Kelley, RN
• Heidi Dawn Kenyon, RN
• Theresa M Kerner, MA, LPC
• Kestrel Medical LLC
• Catherine D Keulks-Torinus, P.A.C.
• Evgeniya Khen, NP

• Primary Care Clinic/Center in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Primary Care Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.