NPIMap

Organization Active NPI

Hospital Authority of Liberty County

  • Surgery Physician
  • Hinesville, GA
National Provider Identifier
1740516129
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
HOSPITAL AUTHORITY OF LIBERTY COUNTY
Practice address
455 S Main St Ste 105
Hinesville, GA 31313-4354
Phone
(912) 876-5505
Fax
(912) 876-5508
NPI assigned
Oct 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Tamera P Mims
Title
Ceo
Phone
(912) 369-9400

Specialties & licenses 1

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

Addresses

Primary practice location

455 S Main St Ste 105
Hinesville, GA 31313-4354

Mailing address

455 S Main St Ste 105
Hinesville, GA 31313-4354
Phone (912) 876-5505

Other names 1

  • Liberty Surgical Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428000377 GA Part B Supplier - Clinic/Group Practice 5799772190 Receives reassigned benefits from 26 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hinesville, GA; Ludowici, GA; Midway, GA

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Hospital Authority of Liberty County9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

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": "1255996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1740516129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST STE 105",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313134354",
            "telephone_number": "912-876-5505",
            "fax_number": "912-876-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST STE 105",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313134354",
            "telephone_number": "912-876-5505",
            "fax_number": "912-876-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF LIBERTY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-20",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "MIMS",
        "authorized_official_first_name": "TAMERA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-369-9400"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Liberty Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hinesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.