Provider Demographics
NPI:1013146448
Name:LIBERTY CARDIOVASCULAR SPECIALISTS
Entity Type:Organization
Organization Name:LIBERTY CARDIOVASCULAR SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-781-7200
Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-407-5430
Mailing Address - Fax:816-407-5435
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-407-5430
Practice Address - Fax:816-407-5435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIBERTY HOSPITAL DISTRICT OF CLAY COUNTY MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-07
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1832Medicare PIN