Liberty Ambulance Service Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

002470 Issued in FL

Legal business name

LIBERTY AMBULANCE SERVICE INC

Practice address

1626 Atlantic University Cir
Jacksonville, FL 32207-2227

Phone

(904) 805-0293

Fax

(904) 724-0226

NPI assigned

Jun 10, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael A Assaf

Title

President

Phone

(904) 721-0008

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305158400000",
    "number": "1407850159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 ATLANTIC UNIVERSITY CIR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072227",
            "telephone_number": "904-805-0293",
            "fax_number": "904-724-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 ATLANTIC UNIVERSITY CIR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072227",
            "telephone_number": "904-805-0293",
            "fax_number": "904-724-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY AMBULANCE SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2011-05-12",
        "status": "A",
        "authorized_official_last_name": "ASSAF",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-721-0008",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "FL",
            "license": "002470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099501100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brent Dalee Libby, MD
• Jennifer Liberato
• Liberator Health and Educational Services, Inc.
• Darlene Liberti
• Claudia Libertin, MD
• Amanda Liberty, LMT
• Laura Lica
• Dee Ray Lichty, CRNA
• Clare Liddon
• Anna Constance Lieber, MS

• Land Ambulance in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Land Ambulance in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.