MEDICARE: LIBERTY OXYGEN AND HOME CARE, 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	5677949	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1030361	OTHER	MN	PREFERRED ONE
3	170158	OTHER	MN	UCARE
4	83371	OTHER	MN	HEALTH PARTNERS
5	79B05LI	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528377058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY OXYGEN AND HOME CARE, INC

Provider Business Mailing Address
First Line	:	4820 PARK GLEN RD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-5702
Country	:	US
Telephone Number	:	952-920-0460
Fax Number	:	952-920-0480

Provider Business Practice Location Address
First Line	:	14001 GRAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5701
Country	:	US
Telephone Number	:	952-898-5008
Fax Number	:	952-898-5009

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	FRANCIS M SHEEHY
Credential	:
Telephone Number	:	952-920-0460

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	11/15/2022

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