Liberty Healthcare LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

140177 Issued in VA

Legal business name

LIBERTY HEALTHCARE LLC

Practice address

5589 Greenwich Rd
Suite 175
Virginia Beach, VA 23462-6565

Phone

(757) 216-9115

Fax

(757) 216-9117

NPI assigned

Nov 5, 2012

Organization subpart

No

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

Authorized official

Name

Derk Pardoe

Title

Partner

Phone

(801) 808-2357

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1720332349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3454 E STONE MOUNTAIN LN",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840926549",
            "telephone_number": "801-808-2357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5589 GREENWICH RD",
            "address_2": "SUITE 175",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234626565",
            "telephone_number": "757-216-9115",
            "fax_number": "757-216-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-05",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "PARDOE",
        "authorized_official_first_name": "DERK",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "801-808-2357"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "140177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.