1285636704 NPI number — LIBERTY MEDICAL, LLC

Table of content: (NPI 1285636704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285636704 NPI number — LIBERTY MEDICAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY MEDICAL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285636704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 N ANDREWS AVE STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-2199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-398-5800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 N ANDREWS AVE STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-2199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-398-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KUNZWEILER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
772-398-5870

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100800030C . This is a "MEDICAID DME" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 164209741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412186400 . This is a "MEDICAID DME" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 009940938 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285636704 . This is a "MEDICAID DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1285636704 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285636704 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285636704 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285636704 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3143280 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 337665000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100202950 . This is a "MEDICAID DME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 76106276 . This is a "MEDICAID DME" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 01008769 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0206008304 . This is a "RESIDENT HME/DME LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1285636704 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285636704 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164711 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000766675B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1234 . This is a "MEDICAID DME" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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