Provider Demographics
NPI:1083859524
Name:LIBERTY WHEELS, LLC
Entity Type:Organization
Organization Name:LIBERTY WHEELS, LLC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-634-2000
Mailing Address - Street 1:714 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2326
Mailing Address - Country:US
Mailing Address - Phone:267-765-1530
Mailing Address - Fax:215-627-2481
Practice Address - Street 1:714 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2326
Practice Address - Country:US
Practice Address - Phone:215-634-2000
Practice Address - Fax:215-701-4976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY RESOURCES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-12
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA84639725332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6347310001Medicare NSC