NPIMap

Organization Active NPI

The Liberty Clinic, Inc.

  • Family Medicine Physician
  • Liberty, MO
National Provider Identifier
1952393977
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
THE LIBERTY CLINIC, INC.
Practice address
122 S Stewart Rd
Liberty, MO 64068-4205
Phone
(816) 781-7730
Fax
(816) 415-1886
NPI assigned
Aug 16, 2005
Organization subpart
Yes
Parent organization
NEW LIBERTY HOSPITAL CORPORATIONAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Joseph W Crossett
Title
Administrator
Phone
(816) 781-7200

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 18

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

National Provider Directory

National Provider Directory
Part of
New Liberty Corporation

Locations

122 S Stewart Rd
Liberty, MO 64068
Phone (816) 781-7730

Specialties & licenses 4

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MO Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MO
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X MO
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MO

Addresses

NPPES NPI Registry

Primary practice location

122 S Stewart Rd
Liberty, MO 64068-4205

Mailing address

2525 Glenn Hendren Dr
Liberty, MO 64068-9625
Phone (816) 781-7200

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
208107406MedicaidMO

Other names 1

NPPES NPI Registry
  • THE LIBERTY CLINIC, P.C. Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952393977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 GLENN HENDREN DR",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689625",
            "telephone_number": "816-781-7200",
            "fax_number": "816-792-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S STEWART RD",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640684205",
            "telephone_number": "816-781-7730",
            "fax_number": "816-415-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIBERTY CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW LIBERTY HOSPITAL CORPORATION",
        "enumeration_date": "2005-08-16",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CROSSETT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "816-781-7200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208107406",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE LIBERTY CLINIC, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Liberty, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.