Provider Demographics
NPI:1679985626
Name:LIBERTY WHEELS, LLC
Entity Type:Organization
Organization Name:LIBERTY WHEELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:FADY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAHHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-634-2000
Mailing Address - Street 1:714 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2326
Mailing Address - Country:US
Mailing Address - Phone:215-634-2000
Mailing Address - Fax:
Practice Address - Street 1:714 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2326
Practice Address - Country:US
Practice Address - Phone:215-634-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY RESOURCES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1024896910001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies