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LIBERTY DIALYSIS - LAFAYETTE LLC NPI 1336239730


NPI Information

NPI: 1336239730
Provider Name: LIBERTY DIALYSIS - LAFAYETTE, LLC

Doing Business As: LIBERTY DIALYSIS - CRAWFORDSVILLE

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 15D1060930

Address:
1710 LAFAYETTE RD
CRAWFORDSVILLE, IN
ZIP 47933
Phone: (765) 359-1613
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LIBERTY DIALYSIS - LAFAYETTE, LLC is an end-stage renal disease (esrd) treatment clinic center in Crawfordsville, IN. LIBERTY DIALYSIS - LAFAYETTE, LLC NPI is 1336239730. The provider is registered as an organization entity type.
The provider Is Doing Business As Liberty Dialysis - Crawfordsville.

The provider's business location address is:

1710 LAFAYETTE RD
CRAWFORDSVILLE, IN
ZIP 47933-033
Phone: (765) 359-1613
Fax: (765) 359-1614

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 15D1060930 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/13/2006 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
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

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

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