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NPI Code Detail

MEDICARE: USRC MEDICAL CENTER, LLC

MEDICARE: USRC MEDICAL CENTER, 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1609261031
Entity Type Code : Organization
Provider Name (Legal Business Name) : USRC MEDICAL CENTER, LLC
Provider Business Mailing Address
First Line : PO BOX 19119
Second Line :
City : JONESBORO
State : AR
Zip : 72403-6601
Country : US
Telephone Number : 870-831-5400
Fax Number : 870-931-5418
Provider Business Practice Location Address
First Line : 4511 NW LOOP 410
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-5124
Country : US
Telephone Number : 972-479-9401
Fax Number : 972-479-9593
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : THOMAS L. WEINBERG
Credential :
Telephone Number : 214-736-2700
Provider Enumeration Date : 04/02/2015
Last Update Date : 01/26/2016

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Directions to “USRC MEDICAL CENTER, LLC ” Practice Location

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