LIBERTY CLINIC LLC NPI 1285302430

NPI Information

NPI: 1285302430
Provider Name: LIBERTY CLINIC LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
1103 E GRACE ST
RENSSELAER, IN
ZIP 47978
Phone: (219) 866-4135
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LIBERTY CLINIC LLC is a multi-specialty clinic center in Rensselaer, IN. LIBERTY CLINIC LLC NPI is 1285302430. The provider is registered as an organization entity type.

The provider's business location address is:

1103 E GRACE ST
RENSSELAER, IN
ZIP 47978-210
Phone: (219) 866-4135
Fax: (219) 866-0803

The provider's authorized official is Randy Curtis Lehman .
The authorized official title is Owner and has the following contact phone number (219) 866-4135.

The enumeration date for this NPI number is 9/2/2021 and was last updated on 6/2/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1912388414	OTHER		INDIVIDUAL NPI
2	300057753	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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