Provider Demographics
NPI:1942446828
Name:LIBERTY HEALTHCARE SUPPLY
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-925-1400
Mailing Address - Street 1:5101 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4126
Mailing Address - Country:US
Mailing Address - Phone:225-925-1400
Mailing Address - Fax:225-355-7266
Practice Address - Street 1:5101 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4126
Practice Address - Country:US
Practice Address - Phone:225-925-1400
Practice Address - Fax:225-355-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-26
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1807915Medicaid
LA1807915Medicaid