Organization
LIBERTY MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN KENNEDY (PRESIDENT)
(772) 398-5800
Entity
Organization
Contact information
Practice address
10400 S US HIGHWAY 1, SUITE 500, PORT ST LUCIE, FL 34952-5600
(866) 836-9936
(888) 640-2184
Mailing address
PO BOX 403970, ATLANTA, GA 30384-3970
(772) 398-5800
(772) 398-2192
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800017356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E9098
MEDICARE PART B - FIRST COAST SERVICE OPTIONS
—
Enumeration date
03/31/2006
Last updated
10/13/2011
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