Provider Demographics
NPI:1073796421
Name:LIBERTY DIALYSIS - FAIRFIELD, LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS - FAIRFIELD, LLC
Other - Org Name:LIBERTY DIALYSIS-FAIRFIELD
Other - Org Type:Doing Business As
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 1:500 KINGS HWY E
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4847
Mailing Address - Country:US
Mailing Address - Phone:203-583-8875
Mailing Address - Fax:203-583-8880
Practice Address - Street 1:500 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4847
Practice Address - Country:US
Practice Address - Phone:203-583-8875
Practice Address - Fax:203-583-8880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
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
072536Medicare Oscar/Certification