| Fmch Liberty Clinic | |
|
1410 Main St E Liberty MS 39645-7268 | |
| (601) 657-8820 | |
| (601) 657-9091 |
| Full Name | Fmch Liberty Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1410 Main St E, Liberty, Mississippi |
| Authorized Official Name and Position | Bernard Richard Williams (CEO) |
| Authorized Official Contact | 6018900500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fmch Liberty Clinic 1410 E Main St Liberty MS 39645-7268 Ph: (601) 657-8820 | Fmch Liberty Clinic 1410 Main St E Liberty MS 39645-7268 Ph: (601) 657-8820 |
| NPI Number | 1669818480 |
|---|---|
| Provider Enumeration Date | 05/20/2013 |
| Last Update Date | 05/21/2026 |
| Certification Date | 05/21/2026 |
| Medicare PECOS PAC ID | 0547248544 |
|---|---|
| Medicare Enrollment ID | O20131014000541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669818480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (NU) | Secondary |
| 207Q00000X | Family Medicine | (NU) | Secondary |
| Provider Name | Harold G Clausen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417958240 PECOS PAC ID: 3971577909 Enrollment ID: I20040824001293 |
| Provider Name | Fred H Petty |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1841291333 PECOS PAC ID: 3375517303 Enrollment ID: I20040824001334 |
| Provider Name | Thomas E Wills |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1578523981 PECOS PAC ID: 0941242499 Enrollment ID: I20050525000681 |
| Provider Name | Richard J Field |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548217847 PECOS PAC ID: 9436191889 Enrollment ID: I20050525000736 |
| Provider Name | Shelby T White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720036890 PECOS PAC ID: 9638103609 Enrollment ID: I20050920001022 |
| Provider Name | Trinity J Mckenzie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255387544 PECOS PAC ID: 7618991951 Enrollment ID: I20060125000499 |
| Provider Name | Robert D Rabalais |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1083630040 PECOS PAC ID: 6800816489 Enrollment ID: I20080730000378 |
| Provider Name | James Lee Hawley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275946162 PECOS PAC ID: 5193047405 Enrollment ID: I20141121002166 |
| Provider Name | Kimberly Diane Gabriel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699054700 PECOS PAC ID: 6507154242 Enrollment ID: I20190903000403 |
| Provider Name | Kristen Womack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114567617 PECOS PAC ID: 1355770231 Enrollment ID: I20200327000587 |
| Provider Name | Amber Flowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811507114 PECOS PAC ID: 9537579396 Enrollment ID: I20210719001154 |
| Provider Name | Amber Watson Malone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851172316 PECOS PAC ID: 5799131132 Enrollment ID: I20231021000577 |
| Provider Name | Shelby T White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720036890 PECOS PAC ID: 9638103609 Enrollment ID: I20260226002271 |
| Provider Name | Samantha Magee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063398725 PECOS PAC ID: 4880197060 Enrollment ID: I20260331003694 |
Amite County Medical Services, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 102 West Freedom Drive, Liberty, MS 39645 Phone: 601-657-4326 Fax: 601-657-8867 |
Liberty Dental Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 102 West Freedom Drive, Liberty, MS 39645 Phone: 601-657-1236 Fax: 601-657-9181 |