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NPI Code Detail

MEDICARE: LIBERTY DIALYSIS - HAWAII LLC

MEDICARE: LIBERTY DIALYSIS - HAWAII 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427099332
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY DIALYSIS - HAWAII LLC
Provider Business Mailing Address
First Line : 91-2137 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-1993
Country : US
Telephone Number : 808-671-3042
Fax Number : 808-677-7903
Provider Business Practice Location Address
First Line : 91-2137 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-1993
Country : US
Telephone Number : 808-671-3042
Fax Number : 808-677-7903
Authorized Official
Title or Position : VICE PRESIDENT
Name : BARRY L. BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 06/10/2006
Last Update Date : 10/17/2023

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Directions to “LIBERTY DIALYSIS - HAWAII LLC ” Practice Location

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