| Organization Name: | LIBERTY DIALYSIS - WOODS CROSS LLC |
| NPI Number: | 1396924957 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN B PARDO (VICE PRESIDENT) |
| Mailing Address: | 572 W 750 S Bldg B Woods Cross |
| State: | UT US |
| Postal Code: | 840107265 |
| Phone Number: | 2062365001 |
| Fax Number: | |
| NPI Enumeration Date: | 10/31/2007 |
| NPI Last Update Date: | 03/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |