Liberty Clinic LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

LIBERTY CLINIC LLC

Practice address

1103 E Grace St
Rensselaer, IN 47978-3210

Phone

(219) 866-4135

Fax

(219) 866-0803

NPI assigned

Sep 2, 2021

Last updated

Jun 2, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Randy Curtis Lehman, MD

Title

Owner

Phone

(219) 866-4135

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654128000000",
    "number": "1285302430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 E GRACE ST",
            "city": "RENSSELAER",
            "state": "IN",
            "postal_code": "479783210",
            "telephone_number": "219-866-4135",
            "fax_number": "219-866-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 E GRACE ST",
            "city": "RENSSELAER",
            "state": "IN",
            "postal_code": "479783210",
            "telephone_number": "219-866-4135",
            "fax_number": "219-866-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-02",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "LEHMAN",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "CURTIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-866-4135",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300057753",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1912388414",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "malberts@mylibertyclinic.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "1103 E Grace St",
            "city": "Rensselaer",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479783210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Rensselaer, IN
• Providers in Rensselaer, IN by specialty
• Multi-Specialty Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.