MEDICARE: LIBERTY PROVIDER CONSULTING & CREDENTIALING

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	1744R1103X	Research Study Abstracter/Coder

General Provider Information

NPI Number	:	1043694722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY PROVIDER CONSULTING & CREDENTIALING

Provider Business Mailing Address
First Line	:	2650 THOUSAND OAKS DR.
Second Line	:	SUITE 2902
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4149
Country	:	US
Telephone Number	:	210-701-3494
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 THOUSAND OAKS DR.
Second Line	:	SUITE 2902
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4149
Country	:	US
Telephone Number	:	210-701-3494
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TRACY GIBSON
Credential	:	CCS
Telephone Number	:	210-701-3494

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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