Provider Demographics
NPI:1043875594
Name:LIBERTY REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:LIBERTY REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:ROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-369-9427
Mailing Address - Street 1:462 ELMA G. MILES PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-369-9478
Mailing Address - Fax:800-611-2089
Practice Address - Street 1:462 ELMA G. MILES PARKWAY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-369-9478
Practice Address - Fax:800-611-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy