Basic Information
| Provider Information | |||||||||
| NPI: | 1558778373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIBERTY HOSPITAL URGENT CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LIBERTY HOSPITAL URGENT CARE-SHOAL CREEK | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 219658 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641219658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164072300 | ||||||||
| FaxNumber: | 8164072301 | ||||||||
| Practice Location | |||||||||
| Address1: | 8300 N CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641581104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164072300 | ||||||||
| FaxNumber: | 8164072301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2014 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | FEESS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO & PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8167817200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LIBERTY HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.