Provider Demographics
NPI:1366578163
Name:LIBERTY MEDICAL EQUIPMENT & SUPPLIES, INC
Entity type:Organization
Organization Name:LIBERTY MEDICAL EQUIPMENT & SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-997-8696
Mailing Address - Street 1:38800 VAN DYKE AVE
Mailing Address - Street 2:SUITE # 900
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1151
Mailing Address - Country:US
Mailing Address - Phone:248-997-8696
Mailing Address - Fax:248-997-1228
Practice Address - Street 1:38800 VAN DYKE AVE
Practice Address - Street 2:SUITE # 900
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1151
Practice Address - Country:US
Practice Address - Phone:248-997-8696
Practice Address - Fax:248-997-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01283E332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5504670002Medicare NSC