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General NPI Number Information
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NPI Number | 1396564019
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Entity Type | Organization
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Legal Business Name | NEW LIBERTY HOSPITAL COPORATION
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 400 W CLAY AVE
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City | PLATTSBURG
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State | MO
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Zip | 64477-1424
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Country | US
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Telephone | 816-415-3460
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W CLAY AVE
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City | PLATTSBURG
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State | MO
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Zip | 64477-1424
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Country | US
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Telephone | 816-415-3460
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JOHN STATON
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Credential |
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Telephone | 816-792-7091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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