Provider Demographics
NPI:1144262692
Name:LIBERTY DIALYSIS-WASHINGTON LLC
Entity type:Organization
Organization Name:LIBERTY DIALYSIS-WASHINGTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:90 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4524
Mailing Address - Country:US
Mailing Address - Phone:724-228-7398
Mailing Address - Fax:724-228-7563
Practice Address - Street 1:90 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4524
Practice Address - Country:US
Practice Address - Phone:724-228-7398
Practice Address - Fax:724-228-7563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-11
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
23281OtherUPMC FOR LIFE MCR
170667OtherUNISON MEDPLUS
392716OtherHIGHMARK BCBS - PPO
PA1013889070001Medicaid
392716OtherHIGHMARK SECURITY MCR
PA1013889070001Medicaid