Provider Demographics
NPI:1578293684
Name:LIBERTY CENTER FAMILY MEDICINE
Entity Type:Organization
Organization Name:LIBERTY CENTER FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:157-430-9628
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:46554-0315
Mailing Address - Country:US
Mailing Address - Phone:574-656-3919
Mailing Address - Fax:574-656-3107
Practice Address - Street 1:100 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:46554-7705
Practice Address - Country:US
Practice Address - Phone:574-656-3919
Practice Address - Fax:574-656-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care