MEDICARE: LIBERATOR HEALTH AND EDUCATIONAL SERVICES, 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1366696817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERATOR HEALTH AND EDUCATIONAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	4651 SALISBURY RD
Second Line	:	SUITE 471
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6107
Country	:	US
Telephone Number	:	772-287-4598
Fax Number	:	800-755-0843

Provider Business Practice Location Address
First Line	:	4651 SALISBURY RD
Second Line	:	SUITE 471
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6107
Country	:	US
Telephone Number	:	772-287-4598
Fax Number	:	800-755-0843

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK ANTHONY LIBRATORE
Credential	:
Telephone Number	:	772-287-4598

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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