LIBERTY DIALYSIS - DUNELAND LLC NPI 1578598249

NPI Information

NPI: 1578598249
Provider Name: LIBERTY DIALYSIS - DUNELAND LLC

Doing Business As: U.S. RENAL CARE LA PORTE DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
103 W 18TH ST
LA PORTE, IN
ZIP 46350
Phone: (219) 326-6362
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LIBERTY DIALYSIS - DUNELAND LLC is an end-stage renal disease (esrd) treatment clinic center in La Porte, IN. LIBERTY DIALYSIS - DUNELAND LLC NPI is 1578598249. The provider is registered as an organization entity type.
The provider Is Doing Business As U.s. Renal Care La Porte Dialysis.

The provider's business location address is:

103 W 18TH ST
LA PORTE, IN
ZIP 46350-631
Phone: (219) 326-6362
Fax: (219) 326-6393

The provider's authorized official is Thomas L. Weinberg .
The authorized official title is Authorized Official and has the following contact phone number (214) 736-2700.

The CLIA number assigned to this NPI record is 15D1059008 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/11/2006 and was last updated on 3/29/2016.

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	152599	MEDICARE OSCAR/CERTIFICATION	INDIANA
2	200834980B	MEDICAID	INDIANA

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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