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LIBERTY MEDICAL, LLC

>> Durable Medical Equipment & Medical Supplies >> Suppliers

Registrant NPI Number: 1285636704

Organizational Registrant:
Organization Name:  LIBERTY MEDICAL, LLC
Organization is Subpart
Authorized Official:  JONATHAN  BLACK  PRESIDENT  772--39-85800

Location and contact information for practice:
2157 APPERSON DR  SALEM, VA 24153-7235 US
Tel: 540-777-0000  Fax: 844-363-4341

Contact information for business:
8881 S US HIGHWAY 1 ATTN: LICENSING PORT SAINT LUCIE, FL 34952-3477 US
Tel: 772-398-2122  Fax: 866-494-9021

Registration Information:
NPI: 1285636704
Entity Type: Organization

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y332B00000XSuppliers
Durable Medical Equipment & Medical Supplies
VA0206008304

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
MEDICAID DME100800030COK01
MEDICAID DME1285636704NY01
1285636704MT05
1285636704NV05
1285636704CA05
4582472TN05
51345ND05
MEDICAID DME76106276NM01
000766675BGA05
003138684CT05
1285636704ID05
164209741AR05
200846870AIN05
RESIDENT HME/DME LICENSE0206008304VA01
1285636704ME05
1285636704IA05
009940938AL05
01008769MS05
164711AZ05
3143280OH05




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