Provider Demographics
NPI:1972376887
Name:LIBERTY TRANSPORT LLC
Entity Type:Organization
Organization Name:LIBERTY TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-755-7433
Mailing Address - Street 1:1090 INDUSTRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-9140
Mailing Address - Country:US
Mailing Address - Phone:859-375-9200
Mailing Address - Fax:
Practice Address - Street 1:1090 INDUSTRY RD
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-9140
Practice Address - Country:US
Practice Address - Phone:859-375-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)