Provider Demographics
NPI:1386014033
Name:LIBERTY PRIMARY TRANSPORTATION
Entity Type:Organization
Organization Name:LIBERTY PRIMARY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCIPIO-BEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-376-0573
Mailing Address - Street 1:21596 LIBBY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2941
Mailing Address - Country:US
Mailing Address - Phone:216-376-0573
Mailing Address - Fax:
Practice Address - Street 1:21596 LIBBY RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2941
Practice Address - Country:US
Practice Address - Phone:216-376-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)