Provider Demographics
NPI:1861671422
Name:LIBERTY DIALYSIS-ST.GEORGE LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS-ST.GEORGE LLC
Other - Org Name:LIBERTY DIALYSIS - ST. GEORGE
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 1:624 S 1000 E STE 101
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5902
Mailing Address - Country:US
Mailing Address - Phone:435-656-4596
Mailing Address - Fax:435-673-6674
Practice Address - Street 1:624 S 1000 E STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5902
Practice Address - Country:US
Practice Address - Phone:435-656-4596
Practice Address - Fax:435-673-6674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-31
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
UT462542OtherPTAN