Healthcare Provider Details

I. General information

NPI: 1396761334
Provider Name (Legal Business Name): LIBERTY ORTHOPEDIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR SUITE 204
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

2521 GLENN HENDREN DR SUITE 204
LIBERTY MO
64068-3388
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-6066
  • Fax: 816-792-5130
Mailing address:
  • Phone: 816-781-6066
  • Fax: 816-792-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number31283
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2002010575
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number110283
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2004021600
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34585
License Number StateMO

VIII. Authorized Official

Name: DR. CRAIG C NEWLAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-781-6066