NPIMap

Organization Active NPI

Liberty Medical Specialties, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Myrtle Beach, SC
National Provider Identifier
1003009069
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
LIBERTY MEDICAL SPECIALTIES, INC.
Practice address
1768 Highway 501
Myrtle Beach, SC 29577-9750
Phone
(843) 448-8315
NPI assigned
Aug 23, 2007
Last updated
Jun 28, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
LIBERTY MEDICAL SPECIALTIES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

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

Authorized official

Name
Mrs. Tamara Lynn Jones
Title
Billing Manager
Phone
(910) 642-2250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1768 Highway 501
Myrtle Beach, SC 29577-9750

Mailing address

PO Box 339
Whiteville, NC 28472-0339
Phone (910) 642-2250

Other identifiers 3

IdentifierTypeStateIssuer
DE3292MedicaidSC
7701229MedicaidNC
0476TOtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101022000456 SC DME Supplier - Oxygen & EquipmentDME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Respiratory Therapist 5496858052 Practice locations: Myrtle Beach, SC

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Liberty Medical Specialties Inc1768 Highway 501, Myrtle Beach, SC 29577-9750(843) 448-8315 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Gastric Suction Pumps|Hospital Beds (Electric)|Hospital Beds (Manual)|Pneumatic Compression Devices and/or Supplies|Support Surfaces: Pres… Does not accept assignmentParticipating since Jan 1, 2017

National Provider Directory

National Provider Directory
Tax ID family
Liberty Medical Specialties Inc11 organizations share this tax ID, including this one
Part of
Liberty Medical Specialties Inc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1003009069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 339",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284720339",
            "telephone_number": "910-642-2250",
            "fax_number": "910-642-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1768 HIGHWAY 501",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295779750",
            "telephone_number": "843-448-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL SPECIALTIES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTY MEDICAL SPECIALTIES, INC.",
        "enumeration_date": "2007-08-23",
        "last_updated": "2011-06-28",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "910-642-2250",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE3292",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7701229",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0476T",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.