Healthcare Provider Details

I. General information

NPI: 1437726296
Provider Name (Legal Business Name): USRC WAHIAWA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KILANI AVE
WAHIAWA HI
96786-2004
US

IV. Provider business mailing address

5851 LEGACY CIR STE 900
PLANO TX
75024-5982
US

V. Phone/Fax

Practice location:
  • Phone: 808-621-5151
  • Fax: 808-621-3884
Mailing address:
  • Phone: 214-736-2700
  • Fax: 214-975-2435

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 AND PRESIDENT
Credential:
Phone: 214-736-2700