Provider Demographics
NPI:1073200473
Name:FREEDOM 7419 LLC
Entity Type:Organization
Organization Name:FREEDOM 7419 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELONYE
Authorized Official - Middle Name:ADKINS
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:432-994-3098
Mailing Address - Street 1:6623 PATRIOT PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-3150
Mailing Address - Country:US
Mailing Address - Phone:432-312-1056
Mailing Address - Fax:
Practice Address - Street 1:4803 PLAZA BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-4913
Practice Address - Country:US
Practice Address - Phone:432-312-1056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy