Healthcare Provider Details

I. General information

NPI: 1750555611
Provider Name (Legal Business Name): USRC MEDINA COUNTY DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 22ND ST
HONDO TX
78861-2520
US

IV. Provider business mailing address

PO BOX 19119
JONESBORO AR
72403-6601
US

V. Phone/Fax

Practice location:
  • Phone: 830-426-3843
  • Fax: 830-426-2239
Mailing address:
  • Phone: 870-931-5400
  • Fax: 870-931-5418

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: SENIOR VICE PRESIDENT
Credential:
Phone: 214-736-2700