Healthcare Provider Details

I. General information

NPI: 1477044840
Provider Name (Legal Business Name): NEW LIBERTY HOSPITAL COPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR STE 402
LIBERTY MO
64068
US

IV. Provider business mailing address

2609 GLENN HENDREN DR
LIBERTY MO
64068-3313
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-8445
  • Fax: 816-781-8413
Mailing address:
  • Phone: 816-407-4555
  • Fax: 816-407-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DAVID H FEESS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 816-781-7200