Liberty Diagnostics

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LIBERTY DIAGNOSTICS

Practice address

1001 12TH Ave Ste 141
Fort Worth, TX 76104-3926

Phone

(972) 402-5497

NPI assigned

Jun 6, 2016

Last updated

Jan 27, 2023By 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

Chris Pratt

Title

Owner

Phone

(972) 402-5497

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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": "1465171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1528417003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11799",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761100799",
            "telephone_number": "972-402-5497",
            "fax_number": "972-755-3748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE STE 141",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043926",
            "telephone_number": "972-402-5497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-06",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-402-5497"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucy Luxi Li, MD
• Ya Li
• Jeffrey E Liang, M.D.
• Lianxi Frank Liao, M.D.
• Cherryll Phoebe Taruc Libed, M.D.
• Liberty Iom LLC
• Megan Elizabeth Liberty, D.O.
• John Licciardone, D.O.
• David M Lichtman, MD
• Joseph Nathan Liddle, MD

• Clinical Medical Laboratory in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.