Liberty University, Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

LIBERTY UNIVERSITY, INC

Practice address

1971 University Blvd
Lynchburg, VA 24515-0002

Phone

(972) 367-4845

NPI assigned

Feb 27, 2019

Organization subpart

No

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

Authorized official

Name

Mouzon Bass III

Title

Administrator

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• Liberty Sports Medicine Doing business as

Tax ID family

Liberty Sports Medicine2 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 University, Inc

  • Sports Medicine (Family Medicine) Physician
  • Lynchburg, VA
  • NPI 1689296360
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Casola, ATC

  • Athletic Trainer
  • Lynchburg, VA
  • NPI 1972846764
  NPD

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551225600000",
    "number": "1750848644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 SPRING VALLEY RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1971 UNIVERSITY BLVD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245150002",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY UNIVERSITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-27",
        "last_updated": "2019-02-27",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Libbey Family Dentistry, Inc
• Anne Zimmerman Libbey, D.D.S.
• Liberty Mountain Medical Group
• Liberty Ridge Healthcare Group, LLC
• Liberty University, Inc
• Nathan Lichti
• Lora N Lieb, AU.D.
• Life Works Therapy
• Light Medical, Inc.
• Cameron Edward Light, DPT, PT

• All providers in Lynchburg, VA
• General Practice Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; 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.