Provider Demographics
NPI:1437184199
Name:LIBERTY DIALYSIS - DUNELAND LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS - DUNELAND LLC
Other - Org Name:DUNELAND DIALYSIS KNOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:PO BOX 638665
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8665
Mailing Address - Country:US
Mailing Address - Phone:615-777-8201
Mailing Address - Fax:
Practice Address - Street 1:1008 EDGEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534
Practice Address - Country:US
Practice Address - Phone:574-772-2480
Practice Address - Fax:574-772-4942
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2017-10-19
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
IN200853190AMedicaid
IN200853190AMedicaid