Provider Demographics
NPI:1659313278
Name:LIBERTY DIALYSIS-BANKSVILLE LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS-BANKSVILLE LLC
Other - Org Name:LIBERTY DIALYSIS-BANKSVILLE, LLC
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 1:2875 BANKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2815
Mailing Address - Country:US
Mailing Address - Phone:412-343-3060
Mailing Address - Fax:412-343-3618
Practice Address - Street 1:2875 BANKSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2815
Practice Address - Country:US
Practice Address - Phone:412-343-3060
Practice Address - Fax:412-343-3618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-11
Last Update Date:2023-10-24
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
PA392727OtherHIGHMARK SECURITY BLUE MC
PA392727OtherUPMC FOR LIFE MCR
392727Medicare ID - Type UnspecifiedPROVIDER NUMBERS