Liberty Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

15D1019268 Issued in IN

Legal business name

LIBERTY LABORATORY INC

Practice address

1317 119TH St
Whiting, IN 46394-1602

Phone

(219) 629-4030

Fax

(708) 488-1831

NPI assigned

Dec 19, 2005

Last updated

May 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Veronica Perez

Title

Delegate

Phone

(812) 548-0086

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1902882210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4531 HARRISON ST",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601621614",
            "telephone_number": "812-619-0413",
            "fax_number": "708-318-4182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 119TH ST",
            "city": "WHITING",
            "state": "IN",
            "postal_code": "463941602",
            "telephone_number": "219-629-4030",
            "fax_number": "708-488-1831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "929 A 12th St",
            "address_purpose": "LOCATION",
            "city": "Tell City",
            "state": "IN",
            "postal_code": "47586",
            "country_code": "US",
            "telephone_number": "812-548-0086",
            "fax_number": "812-548-0089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "132 13th St Ste B",
            "address_purpose": "LOCATION",
            "city": "Tell City",
            "state": "IN",
            "postal_code": "475861918",
            "country_code": "US",
            "telephone_number": "812-548-0086",
            "fax_number": "812-548-0089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIBERTY LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "DELEGATE",
        "authorized_official_telephone_number": "812-548-0086"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": "15D1019268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "000000311554",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300024950",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Michael Fried (united dental centers)
• Rita M. Krilich, P.T.
• Lakeside Foot and Ankle LLC
• Levin Eye Care Center, P.C.
• Steven A Levin, O.D.
• Jayesh M Madhani, MD
• Charru Malik, P.T.
• Jennifer Marlo, PHARMD
• Bridget Anne McCullough-Favela, EDS, NCSP
• Sylvia Mary McKinley, PTA

• Clinical Medical Laboratory in Whiting, IN
• Providers in Whiting, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.