Healthcare Provider Details

I. General information

NPI: 1972376887
Provider Name (Legal Business Name): LIBERTY TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 INDUSTRY RD
HARRODSBURG KY
40330-9140
US

IV. Provider business mailing address

1090 INDUSTRY RD
HARRODSBURG KY
40330-9140
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax:
Mailing address:
  • Phone: 859-375-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LUCILLE KOEHL
Title or Position: OFFICER
Credential:
Phone: 317-755-7433