Organization
LIBERTY MEDICAL RURAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FALLON BROOKE KAY (OFFICE MANAGER)
(936) 336-6439
Entity
Organization
Contact information
Practice address
720 TRAVIS ST, LIBERTY, TX 77575-4828
(936) 336-6439
(936) 336-6517
Mailing address
720 TRAVIS ST, LIBERTY, TX 77575-4828
(936) 336-6439
(936) 336-6517
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
453892
TX
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063414901
—
TX
01
—
CH8297
RR MEDICARE-RH
TX
Enumeration date
07/07/2005
Last updated
10/09/2024
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