Organization
LIBERTY MEDICINE SPECIALISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA G WELCH (MANAGER)
(816) 781-8100
Entity
Organization
Contact information
Practice address
550 RUSH CREEK PKWY, STE B, LIBERTY, MO 64068-9604
(816) 781-8100
(816) 781-3374
Mailing address
550 RUSH CREEK PKWY, STE B, LIBERTY, MO 64068-9604
(816) 781-8100
(816) 781-3374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
110760
MO
207R00000X
Internal Medicine Physician
R6J63
MO
207R00000X
Internal Medicine Physician
R8A47
MO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
109247
MO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
R4935
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06797011
BCBS GROUP NUMBER
MO
05
—
502511207
—
MO
Enumeration date
06/01/2006
Last updated
04/13/2009
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