LIBERTY DIALYSIS - PETERSBURG LLC (NPI# 1790798379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790798379 |
| Entity Type | Organization |
| Organization Name | LIBERTY DIALYSIS - PETERSBURG LLC |
| Practice Address |
3400 S Crater Rd Petersburg VA 23805-9211 |
| Mailing Address |
7650 Se 27th St Suite 200 Mercer Island WA 98040-3060 |
| Practice Telephone | 8047328228 |
| Practice Fax Number | 8047328288 |
| Mailing Telephone | 2062365001 |
| Mailing Fax Number | 2062365002 |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2011-05-25 |
| Authorized Official Name | MR. RYAN B PARDO (VICE PRESIDENT) |
| Authorized Official Telephone | 2062365001 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ANTHEM BCBS OF VA | 195526 | 01 |
| Street Address |
3400 S CRATER RD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710944434 | Sudhakar Chandrakumar Relton | Internal Medicine | 3400 S Crater Rd, Petersburg, VA 23805-9252 | 2006-04-27 |
| 1508201385 | Southside Kidney Specialists | Internal Medicine | 3400 S Crater Rd, Ste #b, Petersburg, VA 23805-9252 | 2013-05-07 |
| 1235376880 | Amar Kumar Damodar | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9252 | 2009-01-18 |
| 1033130026 | Southside Kidney Specialists | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9211 | 2006-07-22 |
| 1669498390 | Tammy Faye Peterson | Dietitian, Registered | 3400 S Crater Rd, Ste.b, Petersburg, VA 23805-9211 | 2006-07-14 |
| 1194773994 | Vijaya Lakshmi Chirumamilla | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9211 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073910600 | Usrc Petersburg, LLC | Clinic/Center | 1964 S Crater Rd, Petersburg, VA 23805-2716 | 2014-11-25 |
| 1366406613 | Trc - Petersburg LLC | Clinic/Center | 20 Medical Park Blvd, Petersburg, VA 23805-9280 | 2006-04-13 |
| 1174596084 | Petersburg Hospital Company LLC | Clinic/Center | 3335 S Crater Rd, Petersburg, VA 23805-9214 | 2006-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497363253 | Fresenius Medical Care Kempsville Home, LLC | Clinic/Center | 6161 Kempsville Cir Ste B, Norfolk, VA 23502-3932 | 2020-07-17 |
| 1760004360 | Renal Treatment Centers - Mid-atlantic, Inc. | Clinic/Center | 7525 Tidewater Dr Ste 37, Norfolk, VA 23505-3700 | 2020-05-18 |
| 1871113746 | Renal Treatment Centers - Mid-atlantic, Inc. | Clinic/Center | 165 Market St Ste 6, Onancock, VA 23417-4233 | 2020-04-21 |
| 1447889399 | Legacy Dialysis of Virginia | Clinic/Center | 211 Gibson St Nw Ste 209, Leesburg, VA 20176-2115 | 2020-04-03 |
| 1457907917 | Renal Treatment Centers - Mid-atlantic, Inc. | Clinic/Center | 570 Westgate Shopping Ctr, Bedford, VA 24523-2643 | 2019-08-12 |
| 1306492848 | Renal Treatment Centers- Mid-atlantic, Inc. | Clinic/Center | 145 Holt Garrison Pkwy Ste 340, Danville, VA 24540-5956 | 2019-08-12 |
| 1043873664 | Branbur Dialysis LLC | Clinic/Center | 4650 Puddledock Rd, Prince George, VA 23875-1235 | 2019-04-18 |
| 1811454226 | Mohansic Dialysis, LLC | Clinic/Center | 8123 Richmond Hwy, Alexandria, VA 22309-3613 | 2019-02-22 |
| 1720552110 | Shawano Dialysis, LLC | Clinic/Center | 13859 Village Place Dr, Midlothian, VA 23114-3503 | 2019-01-18 |
| 1528533171 | Gansett Dialysis, LLC | Clinic/Center | 8605 Westwood Center Dr Ste 100, Vienna, VA 22182-2231 | 2018-10-10 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.