Liberty Medical Supply Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

800017356 Issued in FL

Legal business name

LIBERTY MEDICAL SUPPLY INC

Practice address

10400 S US Highway 1
Suite 500
Port St Lucie, FL 34952-5600

Phone

(866) 836-9936

Fax

(888) 640-2184

NPI assigned

Mar 31, 2006

Organization subpart

No

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

Authorized official

Name

Joan Kennedy

Title

President

Phone

(772) 398-5800

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1245291798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 403970",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303843970",
            "telephone_number": "772-398-5800",
            "fax_number": "772-398-2192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 S US HIGHWAY 1",
            "address_2": "SUITE 500",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525600",
            "telephone_number": "866-836-9936",
            "fax_number": "888-640-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2011-10-13",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-398-5800"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800017356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B - FIRST COAST SERVICE OPTIONS",
            "identifier": "E9098",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawndre Marie Leydon, LMHC
• Gabrielle Lezeau
• Liberty Home Pharmacy Corporation
• Liberty Medical Response Inc
• Liberty Medical Supply Inc
• Life Care Centers of America, Inc.
• Life Chiropractic Center PA
• Life Health Care Inc
• Life Long Learning Center, Inc
• Life Span Inc

• Clinical Medical Laboratory in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; 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.