Liberty III Management TR

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

07498747M Issued in AZ

Legal business name

LIBERTY III MANAGEMENT TR

Doing business as

Professional Medical Oxygen

Practice address

21620 N 19TH Ave
A102
Phoenix, AZ 85027-2716

Phone

(623) 587-0012

Fax

(623) 587-7533

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

David Cornejo Sr.

Title

General Manager

Phone

(623) 587-0012

Specialties & licenses 1

Addresses

Other names 1

• Professional Medical Oxygen Doing business as

Locations

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1932257375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86658",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850806658",
            "telephone_number": "602-509-2001",
            "fax_number": "623-587-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21620 N 19TH AVE",
            "address_2": "A102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850272716",
            "telephone_number": "623-587-0012",
            "fax_number": "623-587-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY III MANAGEMENT TR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "CORNEJO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "623-587-0012",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "07498747M",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Medical Oxygen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Liberty Care LLC
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• Liberty Home LLC
• Liberty Hospice & Palliative Care, Inc
• Liberty Hospice LLC
• Liberty Manor Residency, Inc.
• Liberty Traditional Charter School
• Libery Manor Resideny, Inc. (Liber Manor Residency 2)
• Kyndra Monique Liburd, MD
• Shannon T. Licano

• Durable Medical Equipment & Medical Supplies in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Durable Medical Equipment & Medical Supplies in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; 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.