LIBERTY DIALYSIS PETERSBURG LLC NPI 1790798379

NPI Information

NPI: 1790798379
Provider Name: LIBERTY DIALYSIS PETERSBURG, LLC

Doing Business As: LIBERTY DIALYSIS PETERSBURG LLC

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
3400 S CRATER RD
PETERSBURG, VA
ZIP 23805
Phone: (804) 732-8228
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LIBERTY DIALYSIS PETERSBURG, LLC is an end-stage renal disease (esrd) treatment clinic center in Petersburg, VA. LIBERTY DIALYSIS PETERSBURG, LLC NPI is 1790798379. The provider is registered as an organization entity type.
The provider Is Doing Business As Liberty Dialysis Petersburg Llc.

The provider's business location address is:

3400 S CRATER RD
PETERSBURG, VA
ZIP 23805-252
Phone: (804) 732-8228
Fax: (804) 732-8288

The provider's authorized official is Barry L. Blanton .
The authorized official title is Vice President and has the following contact phone number (781) 699-9000.

The CLIA number assigned to this NPI record is 49D1052367 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/14/2006 and was last updated on 10/17/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	195526	OTHER		ANTHEM BCBS OF VA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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