Liberty Lake Medical Supply, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LIBERTY LAKE MEDICAL SUPPLY, LLC

Practice address

22910 E Appleway Ave Ste 3
Liberty Lake, WA 99019-8606

Phone

(509) 891-2856

Fax

(509) 891-0125

NPI assigned

Jan 2, 2014

Last updated

Jan 2, 2014By 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

Matthew James Brumwell

Title

Manager/Owner

Phone

(509) 710-5259

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388620800000",
    "number": "1366863789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22910 E APPLEWAY AVE STE 3",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990198606",
            "telephone_number": "509-891-2856",
            "fax_number": "509-891-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22910 E APPLEWAY AVE STE 3",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990198606",
            "telephone_number": "509-891-2856",
            "fax_number": "509-891-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY LAKE MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2014-01-02",
        "status": "A",
        "authorized_official_last_name": "BRUMWELL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "509-710-5259"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Love at First Latch

• Durable Medical Equipment & Medical Supplies in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Durable Medical Equipment & Medical Supplies in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; 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.