Provider Demographics
NPI:1679622021
Name:LIBERTY DIALYSIS - DOYLESTOWN LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS - DOYLESTOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-236-5004
Mailing Address - Street 1:3820 E MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3806
Mailing Address - Country:US
Mailing Address - Phone:206-236-5004
Mailing Address - Fax:
Practice Address - Street 1:3820 E MERCER WAY
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3806
Practice Address - Country:US
Practice Address - Phone:206-236-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment