Liberty Eye Surgical Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

17401501 Issued in PA

Legal business name

LIBERTY EYE SURGICAL CENTER

Doing business as

Liberty Surgical Center

Practice address

9122 Blue Grass Rd
Philadelphia, PA 19114-3202

Phone

(215) 673-9231

Fax

(215) 673-9236

NPI assigned

Jan 25, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Edward Michael Quinn

Title

Administrator

Phone

(215) 673-9231

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Liberty Surgical Center Doing business as

Tax ID family

Liberty Eye Surgery Ctr2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Liberty Eye Surgical Center LLC

  • Ambulatory Surgical Clinic/Center
  • Philadelphia, PA
  • NPI 1447218433
  NPD tax ID

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649325713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9122 BLUE GRASS RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191143202",
            "telephone_number": "215-673-9231",
            "fax_number": "215-673-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9122 BLUE GRASS RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191143202",
            "telephone_number": "215-673-9231",
            "fax_number": "215-673-9236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY EYE SURGICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "QUINN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "215-673-9231",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "17401501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009642060001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniella Alcin Libertino, LCSW
• Brooke Liberto
• Liberty Bell Home Care Services, Inc.
• Liberty Community Connections, Inc
• Liberty Dental, LLC (i-dentical)
• Liberty Eye Surgical Center LLC
• Liberty Home Care Services LLC
• Liberty in-Home Health Care LLC
• Liberty Medical Group PC
• Liberty Medical Response LLC.

• Ambulatory Surgical Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.