Healthcare Provider Details

I. General information

NPI: 1508440991
Provider Name (Legal Business Name): USRC EASLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 1ST AVE
EASLEY SC
29640-3039
US

IV. Provider business mailing address

PO BOX 251549
PLANO TX
75025-1500
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-6206
  • Fax:
Mailing address:
  • Phone: 214-736-2700
  • 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
Credential:
Phone: 214-736-2700