Provider Demographics
NPI:1396761334
Name:LIBERTY ORTHOPEDIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LIBERTY ORTHOPEDIC ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:2006-07-14
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31283207X00000X
MO2002010575207X00000X
MO110283207XS0106X
MO2004021600207XX0005X
MO34585207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4775D342Medicare ID - Type Unspecified
MO4759356Medicare ID - Type Unspecified
MO0388010001Medicare NSC
MOC51719Medicare UPIN
MO4775B755Medicare ID - Type Unspecified
MOC51720Medicare UPIN
MOH15902Medicare UPIN
MO4753088Medicare ID - Type Unspecified
MO4750000Medicare ID - Type Unspecified
MOH13929Medicare UPIN
MO4753996Medicare ID - Type Unspecified
MOF23520Medicare UPIN