Provider Demographics
NPI:1720240815
Name:LIBERTY MEDICAL RESPONSE INC
Entity Type:Organization
Organization Name:LIBERTY MEDICAL RESPONSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-398-5800
Mailing Address - Street 1:PO BOX 841863
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1863
Mailing Address - Country:US
Mailing Address - Phone:772-398-5800
Mailing Address - Fax:772-398-2192
Practice Address - Street 1:8883 LIBERTY LN
Practice Address - Street 2:SUITE 150
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3477
Practice Address - Country:US
Practice Address - Phone:772-398-5800
Practice Address - Fax:772-398-2192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY MEDICAL SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-30
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130332/081051650332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies