Provider Demographics
NPI:1669980504
Name:LIBERTY PARK ANESTHESIA SERVICES, LLC
Entity type:Organization
Organization Name:LIBERTY PARK ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-977-9876
Mailing Address - Street 1:1940 STONEGATE DR STE 30
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2540
Mailing Address - Country:US
Mailing Address - Phone:205-977-9876
Mailing Address - Fax:205-977-9976
Practice Address - Street 1:1940 STONEGATE DR STE 30
Practice Address - Street 2:
Practice Address - City:VESTAVIA HLS
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-977-9876
Practice Address - Fax:205-977-9976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTOPHER B HARMON MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-12
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL367500000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty