Organization Active NPI

Liberty Family Care and Wellness PLLC

  • Family Medicine Physician
  • Rowlett, TX
National Provider Identifier
1417636770
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIBERTY FAMILY CARE AND WELLNESS PLLC
Practice address
8701 Liberty Grove Rd Ste 100
Rowlett, TX 75089-2305
Phone
(972) 408-6433
NPI assigned
Jul 13, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Authorized official

Name
Laura Cervantes, APRNNPI 1255879698
Title
Manager
Phone
(972) 348-0046

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

8701 Liberty Grove Rd Ste 100
Rowlett, TX 75089-2305

Mailing address

8701 Liberty Grove Rd Ste 100
Rowlett, TX 75089-2305
Phone (972) 348-0046

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231031000070 TX Part B Supplier - Clinic/Group Practice 8325494172 Receives reassigned benefits from 1 practitioner
Practice locations: Rowlett, TX

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2287653Liberty Family Care & Wellness8701 Liberty Grove Rd Suite 100, Rowlett, TX 75089Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory

Locations

8701 Liberty Grove Rd
Ste 100
Rowlett, TX 75089
Phone (972) 348-0046

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1689206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1417636770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8701 LIBERTY GROVE RD STE 100",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750892305",
            "telephone_number": "972-348-0046",
            "fax_number": "972-257-1885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 LIBERTY GROVE RD STE 100",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750892305",
            "telephone_number": "972-408-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY FAMILY CARE AND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-13",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "CERVANTES",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "972-348-0046",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rowlett, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.