LIBERTY MEDICAL, LLC

Provider Demographics

• NPI: 1285636704
• Name: LIBERTY MEDICAL, LLC
• Entity Type: Organization
• Organization Name: LIBERTY MEDICAL, LLC
• Authorized Official - Title/Position: DIRECTOR OF OPERATIONS
• Authorized Official - First Name: EDWARD
• Authorized Official - Last Name: KUNZWEILER
• Authorized Official - Phone: 772-398-5870
• Mailing Address - Street 1: 5249 NW 33RD AVE
• Mailing Address - City: FORT LAUDERDALE
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33309-6302
• Mailing Address - Country: US
• Mailing Address - Phone: 772-398-5800
• Practice Address - Street 1: 5249 NW 33RD AVE
• Practice Address - City: FORT LAUDERDALE
• Practice Address - State: FL
• Practice Address - Zip Code: 33309-6302
• Practice Address - Country: US
• Practice Address - Phone: 772-398-5800
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: ARX HOLDINGS, LLC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2005-08-15
• Last Update Date: 2022-03-30

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	3336M0002X	Suppliers	Pharmacy	Mail Order Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
AK	1021922	Other	MEDICAID DME
LA	1168025	Medicaid
ID	1285636704	Medicaid
TX	184014202	Medicaid
GA	000766675B	Medicaid
IA	1285636704	Medicaid
NV	1285636704	Medicaid
OH	3143280	Medicaid
TN	4582472	Medicaid
SC	DM1234	Other	MEDICAID DME
VA	0206008304	Other	RESIDENT HME/DME LICENSE
OK	100800030C	Other	MEDICAID DME
NM	76106276	Other	MEDICAID DME
AL	009940938	Medicaid
MI	1285636704	Medicaid
WA	1285636704	Medicaid
AR	164209741	Medicaid
IN	200846870A	Medicaid
MD	412186400	Other	MEDICAID DME
NJ	0125491	Medicaid
MT	1285636704	Medicaid
UT	1285636704	Medicaid
CA	1285636704	Medicaid
AZ	164711	Medicaid
CT	003138684	Medicaid
MS	01008769	Medicaid
VA	1285636704	Medicaid
MN	337665000	Medicaid
KY	7100202950	Other	MEDICAID DME
DC	035411800	Other	MEDICAID DME
NE	100254752-00	Medicaid
NY	1285636704	Other	MEDICAID DME
ME	1285636704	Medicaid
ND	51345	Medicaid
MN	337665000	Medicaid
OH	3143280	Medicaid
NE	100254752-00	Medicaid
MS	01008769	Medicaid
VA	0333860005	Medicare NSC
TN	4582472	Medicaid
AR	164209741	Medicaid
MT	1285636704	Medicaid
AK	1028985	Other	MEDICAID PHARMACY
SC	DM1234	Other	MEDICAID DME
MN	337665000	Medicaid
ID	1285636704	Medicaid
NY	03288575	Other	MEDICAID PHARMACY
MN	337665000	Medicaid
HI	52532103	Medicaid
ID	1285636704	Medicaid