Provider Demographics
NPI:1821355504
Name:LIBERTY DIALYSIS - HAWAII LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS - HAWAII LLC
Other - Org Name:LIBERTY DIALYSIS HAWAII - HAWAII KAI DIALYSIS
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 1:7192 KALANIANAOLE HWY STE Q101
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1850
Mailing Address - Country:US
Mailing Address - Phone:808-394-6274
Mailing Address - Fax:808-394-6503
Practice Address - Street 1:7192 KALANIANAOLE HWY STE Q101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1850
Practice Address - Country:US
Practice Address - Phone:808-394-6274
Practice Address - Fax:808-394-6503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-18
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
HI12-2527OtherPTAN