Provider Demographics
NPI:1376568121
Name:NEW LIBERTY MEDICAL & HOSPITAL CORP
Entity Type:Organization
Organization Name:NEW LIBERTY MEDICAL & HOSPITAL CORP
Other - Org Name:PLATTSBURG MEDICAL CLINIC RURAL HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FEEKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-415-3460
Mailing Address - Street 1:400 W CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64477-1424
Mailing Address - Country:US
Mailing Address - Phone:816-415-3460
Mailing Address - Fax:816-415-3461
Practice Address - Street 1:400 W CLAY AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-1424
Practice Address - Country:US
Practice Address - Phone:816-539-2117
Practice Address - Fax:816-539-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595949900Medicaid
MO263929Medicare Oscar/Certification