Provider Demographics
NPI:1396564019
Name:NEW LIBERTY HOSPITAL COPORATION
Entity type:Organization
Organization Name:NEW LIBERTY HOSPITAL COPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-792-7091
Mailing Address - Street 1:400 W CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64477-1424
Mailing Address - Country:US
Mailing Address - Phone:816-415-3460
Mailing Address - Fax:
Practice Address - Street 1:400 W CLAY AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-1424
Practice Address - Country:US
Practice Address - Phone:816-415-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIBERTY HOSPITAL COPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty