Provider Demographics
NPI:1639360209
Name:LIBERTY DIALYSIS - DUNCANVILLE LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS - DUNCANVILLE LLC
Other - Org Name:PREMIER DIALYSIS - DUNCANVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHAIRMAN
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:214-736-2730
Mailing Address - Street 1:PO BOX 844631
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4631
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:214-736-2701
Practice Address - Street 1:1038 US HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2704
Practice Address - Country:US
Practice Address - Phone:214-302-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-07
Last Update Date:2023-07-24
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
TX205708501Medicaid
TX672600Medicare Oscar/Certification