Provider Demographics
NPI:1821518630
Name:NEW LIBERTY HOSPITAL COPORATION
Entity Type:Organization
Organization Name:NEW LIBERTY HOSPITAL COPORATION
Other - Org Name:LIBERTY HOSPITAL PRIMARY CARE SHOAL CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-781-7200
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-407-4555
Mailing Address - Fax:
Practice Address - Street 1:8380 N TULLIS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158
Practice Address - Country:US
Practice Address - Phone:816-415-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO57333017OtherBCBS