Provider Demographics
NPI:1598095234
Name:LIBERTY FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:LIBERTY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEDA
Authorized Official - Middle Name:NASH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-226-8474
Mailing Address - Street 1:7136 OFFICE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2261
Mailing Address - Country:US
Mailing Address - Phone:513-755-1912
Mailing Address - Fax:513-755-2013
Practice Address - Street 1:7136 OFFICE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2261
Practice Address - Country:US
Practice Address - Phone:513-755-1912
Practice Address - Fax:513-755-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty