Active NPI
Liberty Portable X-Ray Ohio LLC
- Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
- Fremont, OH
National Provider Identifier
1497228969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
- Legal business name
- LIBERTY PORTABLE X-RAY OHIO LLC
- Practice address
- 1430 Oak Harbor Rd
Fremont, OH 43420-1025 - Phone
- (717) 607-1700
- NPI assigned
- Jan 8, 2019
- Organization subpart
- Yes
- Parent organization
- LIBERTY PORTABLE X-RAY OHIO LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Danielle Philipps
- Title
- Director of Operations
- Phone
- (717) 607-1700
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 335V00000X | Primary |
Addresses
Primary practice location
1430 Oak Harbor Rd
Fremont, OH 43420-1025
Mailing address
955 Broadway
Woodmere, NY 11598-1733
Phone (717) 607-1700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Portable X-ray supplier certification: CCN 36X0009884
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- LIBERTY PORTABLE X RAY OHIO LLC
- Certification status
- Active
- Provider type (POS)
- Portable X-ray supplier
- Participating since
- Jan 19, 2021
- Last certification
- Jan 19, 2021
- Ownership / control type
- Partnership
- Facility address
- 1430 Oak Harbor Road
Fremont, OH 43420
National Provider Directory
National Provider Directory- Part of
- Liberty Portable X-Ray Ohio
Locations
85 W Hawthorne Ave
Valley Stream, NY 11580
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1706400000000",
"number": "1497228969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "955 BROADWAY",
"city": "WOODMERE",
"state": "NY",
"postal_code": "115981733",
"telephone_number": "717-607-1700",
"fax_number": "717-607-1710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 OAK HARBOR RD",
"city": "FREMONT",
"state": "OH",
"postal_code": "434201025",
"telephone_number": "717-607-1700"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIBERTY PORTABLE X-RAY OHIO LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LIBERTY PORTABLE X-RAY OHIO LLC",
"enumeration_date": "2019-01-08",
"last_updated": "2024-01-28",
"certification_date": "2024-01-28",
"status": "A",
"authorized_official_last_name": "PHILIPPS",
"authorized_official_first_name": "DANIELLE",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
"authorized_official_telephone_number": "717-607-1700"
},
"taxonomies": [
{
"code": "335V00000X",
"taxonomy_group": "",
"desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.