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NPI Code Detail

MEDICARE: LIBERTY HOME MEDICAL SUPPLY

MEDICARE: LIBERTY HOME MEDICAL SUPPLY
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
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
154OH228090OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1992880462
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY HOME MEDICAL SUPPLY
Provider Business Mailing Address
First Line : 20509 NORTHVILLE PARK PL
Second Line : #2006
City : NORTHVILLE
State : MI
Zip : 48167-2939
Country : US
Telephone Number : 248-844-9669
Fax Number : 248-844-9651
Provider Business Practice Location Address
First Line : 1904 STAR BATT DR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48309-3711
Country : US
Telephone Number : 248-844-9669
Fax Number : 248-844-9651
Authorized Official
Title or Position : DIRECTOR
Name : MR. JOHN MICHAEL HAYES
Credential : RN
Telephone Number : 248-844-9669
Provider Enumeration Date : 10/25/2006
Last Update Date : 08/22/2020

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Directions to “LIBERTY HOME MEDICAL SUPPLY ” Practice Location

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