MEDICARE: LIBERTY EMS SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)
2	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1740696988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY EMS SERVICES LLC

Provider Business Mailing Address
First Line	:	28500 GILCHRIST DR
Second Line	:
City	:	WILLOWICK
State	:	OH
Zip	:	44095-4566
Country	:	US
Telephone Number	:	440-227-1768
Fax Number	:

Provider Business Practice Location Address
First Line	:	1294 W 70TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2018
Country	:	US
Telephone Number	:	216-630-6626
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	MRS. SUSAN DORIS RUSHWORTH
Credential	:
Telephone Number	:	440-227-1768

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/09/2014

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Directions to “LIBERTY EMS SERVICES LLC ” Practice Location

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