LIBERTY DIALYSIS-WEBER COUNTY LLC NPI 1770951030

NPI Information

NPI: 1770951030
Provider Name: LIBERTY DIALYSIS-WEBER COUNTY, LLC

Doing Business As: SOUTH OGDEN HOME

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
475 40TH ST STE 110
SOUTH OGDEN, UT
ZIP 84403
Phone: (801) 627-2886
Get Directions

LIBERTY DIALYSIS-WEBER COUNTY, LLC is an end-stage renal disease (esrd) treatment clinic center in South Ogden, UT. LIBERTY DIALYSIS-WEBER COUNTY, LLC NPI is 1770951030. The provider is registered as an organization entity type.
The provider Is Doing Business As South Ogden Home.

The provider's business location address is:

475 40TH ST STE 110
SOUTH OGDEN, UT
ZIP 84403-856
Phone: (801) 627-2886
Fax: (801) 621-1570

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 46D2104224 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/3/2015 and was last updated on 10/19/2023.

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		UTAH	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	462547	OTHER	UTAH	PTAN

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: 4/28/2024

NPI Synchronization or Removal

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