# LIBERTY MEDICAL SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194337683
- **Authorized official:** IVAN ASHLEY FERGUSON (OWNER)
- **Authorized official phone:** (844) 397-5011

## Contact information

- **Practice address:** 1700 N DIXIE HWY STE 116, BOCA RATON, FL 33432-1807
- **Practice address phone:** (844) 397-5011
- **Mailing address:** 1700 N DIXIE HWY STE 116, BOCA RATON, FL 33432-1807
- **Mailing address phone:** (844) 397-5011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 08/18/2020
- **Last updated:** 04/28/2022