Organization
LIBERTY MEDICAL, LLC
Active
Parent organization
LIBERTY MEDICAL HOLDINGS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIBERTY MEDICAL HOLDINGS, LLC
Authorized official
JONATHAN SETH BLACK (PRESIDENT)
(772) 398-5800
Entity
Organization
Contact information
Practice address
20 FALL PIPPIN LN, SUITE 203, ASHEVILLE, NC 28803-2512
(888) 720-0921
(844) 363-4341
Mailing address
8881 LIBERTY LN, ATTN: LICENSING, PORT SAINT LUCIE, FL 34952-3477
(772) 398-2122
(844) 363-4341
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
02243
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02243
RESIDENT HME/DME LICENSE
NC
05
—
1568785434
—
SC
05
—
7705272
—
NC
Enumeration date
03/08/2010
Last updated
03/22/2018
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