=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740744689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIBERTY POINT ACUPUNCTURE AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2019
-----------------------------------------------------
Last Update Date | 09/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 242 CRAVEN ST
-----------------------------------------------------
City | NEW BERN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28560-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-658-4661
-----------------------------------------------------
Fax | 252-631-2306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310A NEW ST
-----------------------------------------------------
City | NEW BERN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28560-4937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-494-2649
-----------------------------------------------------
Fax | 252-631-2306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARY BETH JONES-PRIZER
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 910-494-2649
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------