Provider Demographics
NPI:1598845042
Name:LIBERTY FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:LIBERTY FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-896-3033
Mailing Address - Street 1:571 E TURKEYFOOT LAKE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-4122
Mailing Address - Country:US
Mailing Address - Phone:330-896-3033
Mailing Address - Fax:330-896-5692
Practice Address - Street 1:571 E TURKEYFOOT LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319
Practice Address - Country:US
Practice Address - Phone:330-896-3033
Practice Address - Fax:330-896-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080156797OtherRR MEDICARE
OH2148974Medicaid
OH2148974Medicaid
OH080156797OtherRR MEDICARE