Provider Demographics
NPI:1407298243
Name:LIBERTY BELL LABORATORY INC
Entity Type:Organization
Organization Name:LIBERTY BELL LABORATORY INC
Other - Org Name:LIBERTY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-548-0086
Mailing Address - Street 1:929 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1603
Mailing Address - Country:US
Mailing Address - Phone:812-548-0086
Mailing Address - Fax:812-548-0089
Practice Address - Street 1:929 12TH ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1603
Practice Address - Country:US
Practice Address - Phone:812-548-0086
Practice Address - Fax:812-548-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory