Provider Demographics
NPI:1003529280
Name:LIBERTY HEALTHCARE PARTNERS
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-290-7800
Mailing Address - Street 1:1949 GUNBARREL RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3486
Mailing Address - Country:US
Mailing Address - Phone:423-498-5839
Mailing Address - Fax:
Practice Address - Street 1:1949 GUNBARREL RD STE 303
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3486
Practice Address - Country:US
Practice Address - Phone:423-498-5839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty