Healthcare Provider Details

I. General information

NPI: 1407633266
Provider Name (Legal Business Name): SATELLITE FOLSOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLUE RAVINE RD STE 100
FOLSOM CA
95630-4795
US

IV. Provider business mailing address

5851 LEGACY CIR STE 900
PLANO TX
75024-5982
US

V. Phone/Fax

Practice location:
  • Phone: 916-365-8100
  • Fax: 916-351-3865
Mailing address:
  • Phone: 214-736-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS L WEINBERG
Title or Position: CHAIRMAN & PRESIDENT
Credential:
Phone: 214-736-2700