NPIMap

Organization Active NPI

Liberty Surgical Associates, PLLC

  • Surgery Physician
  • Holland, MI
National Provider Identifier
1669611125
Registry record updated Jan 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301068128 Issued in MI
Legal business name
LIBERTY SURGICAL ASSOCIATES, PLLC
Practice address
400 136TH Ave
Suite 416
Holland, MI 49424-2923
Phone
(616) 738-0470
Fax
(616) 738-0498
NPI assigned
Feb 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2012

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

Authorized official

Name
Dr. Liberty Belle Shelton Hoberman, MD
Title
General Surgeon
Phone
(616) 738-0470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 4301068128 MI Primary

Addresses

Primary practice location

400 136TH Ave
Suite 416
Holland, MI 49424-2923

Mailing address

400 136TH Ave
Suite 416
Holland, MI 49424-2923
Phone (616) 738-0470

National Provider Directory

National Provider Directory

Locations

400 136th Ave
Ste 416
Holland, MI 49424
Phone (616) 738-0470

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": "1233878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327276800000",
    "number": "1669611125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 136TH AVE",
            "address_2": "SUITE 416",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242923",
            "telephone_number": "616-738-0470",
            "fax_number": "616-738-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 136TH AVE",
            "address_2": "SUITE 416",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242923",
            "telephone_number": "616-738-0470",
            "fax_number": "616-738-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY SURGICAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-06",
        "last_updated": "2012-01-23",
        "status": "A",
        "authorized_official_last_name": "HOBERMAN",
        "authorized_official_first_name": "LIBERTY BELLE",
        "authorized_official_middle_name": "SHELTON",
        "authorized_official_title_or_position": "GENERAL SURGEON",
        "authorized_official_telephone_number": "616-738-0470",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301068128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; 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.