Liberty Dialysis Pueblo LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

LIBERTY DIALYSIS PUEBLO LLC

Doing business as

U.S. Renal Care Pueblo Dialysis

Practice address

850 Eagle Ridge Blvd
Pueblo, CO 81008-2148

Phone

(719) 253-5980

Fax

(719) 583-0833

NPI assigned

Feb 15, 2008

Last updated

Mar 31, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

U.S. RENAL CARE, INC.As reported in NPPES

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

Authorized official

Name

Thomas L. Weinberg

Title

Authorized Official

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• U.S. Renal Care Pueblo Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

US Renal Care Inc

Member of 1

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

• Dialysis Newco LLC

  dba U.S. Renal Care Bryan Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bryan, TX
  • NPI 1578839080

  Member Of

  NPD member

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459382400000",
    "number": "1790953453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 CHURCH ST",
            "address_2": "SUITE 1900",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192301",
            "telephone_number": "615-777-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 EAGLE RIDGE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082148",
            "telephone_number": "719-253-5980",
            "fax_number": "719-583-0833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DIALYSIS PUEBLO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2008-02-15",
        "last_updated": "2016-03-31",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "214-736-2700"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02224887",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U.S. Renal Care Pueblo Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Larry Wayne Lewis, RN
• Nia Lewis
• Lynn R Leyba, NP, CNM
• Michael Edward Leyba, MA,LPC,CACIII
• Stephanie Dana Leyba, BA, CACI
• Kenneth John Liddiard, DMD
• Alexa Nell Lieb, OTR/L
• John P Lieberman, M.D.
• Dana G Lieser, LPN
• Life Choice Hospice of Colorado II, LLC (Compassus - Greater Colorado Springs)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pueblo, CO
• Providers in Pueblo, CO by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.