Healthcare Provider Details

I. General information

NPI: 1013146448
Provider Name (Legal Business Name): LIBERTY CARDIOVASCULAR SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR SUITE 306
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

2521 GLENN HENDREN DR SUITE 306
LIBERTY MO
64068-3388
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-5430
  • Fax: 816-407-5435
Mailing address:
  • Phone: 816-407-5430
  • Fax: 816-407-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH W CROSSETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 816-781-7200