MEDICARE: LIBERTY MEDICAL SPECIALTIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0476T	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003009069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY MEDICAL SPECIALTIES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-0339
Country	:	US
Telephone Number	:	910-642-2250
Fax Number	:	910-642-0109

Provider Business Practice Location Address
First Line	:	1768 HIGHWAY 501
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-9750
Country	:	US
Telephone Number	:	843-448-8315
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. TAMARA LYNN JONES
Credential	:
Telephone Number	:	910-642-2250

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	06/28/2011

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