Provider Demographics
NPI:1629212709
Name:LIBERTY HOSPITAL PHYSICIAN CLINICS
Entity Type:Organization
Organization Name:LIBERTY HOSPITAL PHYSICIAN CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:FEESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-781-7200
Mailing Address - Street 1:2609 GLENN HENDREN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-4209
Mailing Address - Country:US
Mailing Address - Phone:816-781-7730
Mailing Address - Fax:816-415-1886
Practice Address - Street 1:2609 GLENN HENDREN DRIVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-4209
Practice Address - Country:US
Practice Address - Phone:816-781-7730
Practice Address - Fax:816-415-1886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIBERTY HOSPITAL DISTRICT OF CLAY COUNTY MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-21
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 208000000X
MO110739207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO9959OtherMEDICARE RAILROAD