Provider Demographics
NPI:1922280148
Name:LIBERTY ORTHOPEDIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:LIBERTY ORTHOPEDIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAROL
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-781-6066
Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-6066
Mailing Address - Fax:816-792-5130
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-6066
Practice Address - Fax:816-792-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0388010001Medicare NSC