MEDICARE: LIBERATOR MEDICAL SUPPLY, 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

General Provider Information

NPI Number	:	1164652558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERATOR MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	1823 SE AIRPORT RD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34996-4012
Country	:	US
Telephone Number	:	800-323-0914
Fax Number	:	877-730-7796

Provider Business Practice Location Address
First Line	:	1823 SE AIRPORT RD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34996-4012
Country	:	US
Telephone Number	:	800-323-0914
Fax Number	:	877-730-7796

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROBERT EMERSON
Credential	:
Telephone Number	:	800-323-0914

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/22/2025

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