Provider Demographics
NPI:1710080296
Name:LIBERTY MEDICAL SPECIALTIES INC
Entity Type:Organization
Organization Name:LIBERTY MEDICAL SPECIALTIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-642-2250
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0339
Mailing Address - Country:US
Mailing Address - Phone:910-642-2250
Mailing Address - Fax:
Practice Address - Street 1:2224 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7515
Practice Address - Country:US
Practice Address - Phone:910-763-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3436676OtherNCPDP#
NC0473GOtherBCBS IV
NC6800282Medicaid
NC0656091Medicaid
NC0656091Medicaid