NPIMap

Organization Active NPI

Liberty Medical Specialties, Inc

  • Durable Medical Equipment & Medical Supplies
  • Whiteville, NC
National Provider Identifier
1104921998
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
612-10 E Jefferson St
Whiteville, NC 28472
Phone
(910) 642-2250
Fax
(910) 642-0109
NPI assigned
Sep 14, 2006
Organization subpart
No

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
Mr. 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

612-10 E Jefferson St
Whiteville, NC 28472

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
0476TOtherNCBCBS
7701229MedicaidNC
DME694MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930074889 NC DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered PharmacistDME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Oxygen & Equipment 5496858052 1 other NPI on this enrollment
Practice locations: Whiteville, NC
O20110222000570 NC Part B Supplier - Pharmacy 5496858052 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Whiteville, NC

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Liberty Medical Specialties11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1804 Owen Dr
Fayetteville, NC 28304
Phone (910) 864-3810

108 Randolph St
Ste 3
Thomasville, NC 27360
Phone (336) 472-1741

612 Jefferson St
#10
Whiteville, NC 28472

612 Jefferson St
Ste 10
Whiteville, NC 28472

2224 S 17th St
Wilmington, NC 28401
Phone (910) 763-8229

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1104921998",
    "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": "612-10 E JEFFERSON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "28472",
            "telephone_number": "910-642-2250",
            "fax_number": "910-642-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL SPECIALTIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "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": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0476T",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7701229",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME694",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.