Provider Demographics
NPI:1104827781
Name:LIBERTY EMERGENCY PHYSICIANS, INC.
Entity Type:Organization
Organization Name:LIBERTY EMERGENCY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-391-7597
Mailing Address - Street 1:PO BOX 411375
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1375
Mailing Address - Country:US
Mailing Address - Phone:816-781-9222
Mailing Address - Fax:
Practice Address - Street 1:2525 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9625
Practice Address - Country:US
Practice Address - Phone:816-792-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30768018OtherBLUE CROSS BLUE SHIELD MO
MO505906701Medicaid
MO30768018OtherBLUE CROSS BLUE SHIELD MO