MEDICARE: USRC FALL CREEK, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1366259962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USRC FALL CREEK, LLC

Provider Business Mailing Address
First Line	:	9356 N SAM HOUSTON PKWY E STE 100
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4378
Country	:	US
Telephone Number	:	281-201-1555
Fax Number	:	281-201-4348

Provider Business Practice Location Address
First Line	:	9356 N SAM HOUSTON PKWY E STE 100
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4378
Country	:	US
Telephone Number	:	281-201-1555
Fax Number	:	281-201-4348

Authorized Official
Title or Position	:	CHAIRMAN AND PRESIDENT
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2730

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	01/22/2025

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