MEDICARE: MR. BERNARD E LIBEL B. A., BC-HIS

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	174400000X	Specialist	2002030817	MO

General Provider Information

NPI Number	:	1700041522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BERNARD E LIBEL B. A., BC-HIS

Provider Business Mailing Address
First Line	:	1105 S BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64507-2224
Country	:	US
Telephone Number	:	816-676-2900
Fax Number	:	816-676-2901

Provider Business Practice Location Address
First Line	:	1105 S BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64507-2224
Country	:	US
Telephone Number	:	816-676-2900
Fax Number	:	816-676-2901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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