NPIMap

Organization Active NPI

LDBH, LLC

Doing business as Liberty Dialysis at Lakeland Watervliet

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Watervliet, MI
National Provider Identifier
1629372628
Registry record updated Aug 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
LDBH, LLC
Doing business as
Liberty Dialysis at Lakeland Watervliet
Practice address
400 Medical Park Dr
Watervliet, MI 49098-9225
Phone
(269) 684-0116
Fax
(269) 684-0271
NPI assigned
Jan 5, 2011
Last updated
Aug 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ryan B Pardo
Title
Vice President
Phone
(206) 236-5001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

400 Medical Park Dr
Watervliet, MI 49098-9225

Mailing address

7650 SE 27TH St
Suite 200
Mercer Island, WA 98040-3060
Phone (206) 588-8621

Other names 1

  • Liberty Dialysis at Lakeland Watervliet Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

  • LDBH LLC

    dba Liberty Dialysis at Lakeland Benton Harbor

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Benton Harbor, MI
    • NPI 1407150279
    NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344988800000",
    "number": "1629372628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7650 SE 27TH ST",
            "address_2": "SUITE 200",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980403060",
            "telephone_number": "206-588-8621",
            "fax_number": "206-588-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "269-684-0116",
            "fax_number": "269-684-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LDBH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2012-08-15",
        "status": "A",
        "authorized_official_last_name": "PARDO",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "206-236-5001"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Dialysis at Lakeland Watervliet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watervliet, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.