Provider Demographics
NPI:1114702149
Name:LIBERTY HEALTHCARE PARTNERS
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-763-4576
Mailing Address - Street 1:1017 EXECUTIVE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7911
Mailing Address - Country:US
Mailing Address - Phone:423-498-5839
Mailing Address - Fax:423-449-8258
Practice Address - Street 1:1017 EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7911
Practice Address - Country:US
Practice Address - Phone:423-870-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY HEALTHCARE PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-28
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care