MEDICARE: LIBERTY DIALYSIS - DUNELAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1457383069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY DIALYSIS - DUNELAND LLC

Provider Business Mailing Address
First Line	:	424 CHURCH ST
Second Line	:	SUITE 1900
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2301
Country	:	US
Telephone Number	:	615-777-8201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 VILLAGE POINT
Second Line	:	SUITE 101
City	:	CHESTERTON
State	:	IN
Zip	:	46304-9689
Country	:	US
Telephone Number	:	219-395-8020
Fax Number	:	219-395-1015

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/29/2016

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