Provider Demographics
NPI:1891075941
Name:LIBERTY BELL GROUP, INC.
Entity type:Organization
Organization Name:LIBERTY BELL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-222-6002
Mailing Address - Street 1:8768 SW 8TH ST
Mailing Address - Street 2:10
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3201
Mailing Address - Country:US
Mailing Address - Phone:305-222-6002
Mailing Address - Fax:305-222-6003
Practice Address - Street 1:8768 SW 8TH ST
Practice Address - Street 2:10
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3201
Practice Address - Country:US
Practice Address - Phone:305-222-6002
Practice Address - Fax:305-222-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-21
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty