Healthcare Provider Details

I. General information

NPI: 1477512895
Provider Name (Legal Business Name): USRC SA TRI COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19910 INTERSTATE 35 S STE 101
LYTLE TX
78052-3547
US

IV. Provider business mailing address

PO BOX 251549
PLANO TX
75025-1500
US

V. Phone/Fax

Practice location:
  • Phone: 830-772-5784
  • Fax:
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 Number008135
License Number StateTX

VIII. Authorized Official

Name: THOMAS L WEINBERG
Title or Position: VP, GENERAL COUNSEL
Credential:
Phone: 214-736-2700