NPIViewer - Provider NPI 1407837206

NPI:	1407837206
Name:	LIBERTY MEDICAL, LLC
Entity type:	Organization
Organization Name:	LIBERTY MEDICAL, LLC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:	EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:	KUNZWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	772-398-5870
Mailing Address - Street 1:	5249 NW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:	FORT LAUDERDALE
Mailing Address - State:	FL
Mailing Address - Zip Code:	33309-6302
Mailing Address - Country:	US
Mailing Address - Phone:	866-245-1483
Mailing Address - Fax:	844-574-3257
Practice Address - Street 1:	5249 NW 33RD AVE
Practice Address - Street 2:
Practice Address - City:	FORT LAUDERDALE
Practice Address - State:	FL
Practice Address - Zip Code:	33309-6302
Practice Address - Country:	US
Practice Address - Phone:	866-245-1483
Practice Address - Fax:	844-574-3257
EIN:	<UNAVAIL>
Is Organization Subpart?:	Yes
Parent Organization LBN:	ARX HOLDINGS, LLC
Parent Organization TIN:	<UNAVAIL>
Enumeration Date:	2005-11-09
Last Update Date:	2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

State	Identifier ID	ID Type
KS	100309870B	Medicaid
PA	100772815-0011	Medicaid
SD	1407837206	Medicaid
VA	1407837206	Medicaid
IN	200118000B	Medicaid
RI	3860001	Medicaid
AZ	734245	Medicaid
SC	DE1068	Medicaid
WV	0227348000	Medicaid
DC	0332701-00	Medicaid
NH	3092227	Medicaid
KY	7100202680	Medicaid
NJ	0372552	Medicaid
AK	1021921	Medicaid
WI	1407837206	Medicaid
ME	1407837206	Medicaid
WA	1407837206	Medicaid
VT	1407837206	Medicaid
WY	1407837206	Medicaid
MT	1407837206	Medicaid
MD	113400100	Medicaid
AR	130420741	Medicaid
NY	1407837206	Medicaid
OH	2198009	Medicaid
IA	1407837206	Medicaid
AL	009703530	Medicaid
UT	1407837206	Medicaid
NE	1407837206	Medicaid
TN	4581708	Medicaid
MN	9485121-00	Medicaid
FL	015439700	Medicaid
ID	1407837206	Medicaid
CA	1407837206	Medicaid
ND	51437	Medicaid
OK	100800030A	Medicaid
DE	1407837206	Medicaid
OR	295413	Medicaid
NM	S3736	Medicaid
FL	0333860001	Medicare NSC
DE	1407837206	Medicaid
CA	1407837206	Medicaid
FL	0333860001	Medicare NSC
WV	0227348000	Medicaid
OH	2198009	Medicaid
WI	1407837206	Medicaid
ME	186510000	Medicaid
AZ	734245	Medicaid
SD	9166790	Medicaid
ID	M0021349	Medicaid