Healthcare Provider Details

I. General information

NPI: 1407030364
Provider Name (Legal Business Name): USRC WEST FORT WORTH DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 S CHERRY LN SUITE 200
WHITE SETTLEMENT TX
76108-3629
US

IV. Provider business mailing address

PO BOX 251549
PLANO TX
75025-1500
US

V. Phone/Fax

Practice location:
  • Phone: 817-367-0822
  • Fax: 817-367-1520
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: MR. THOMAS L WEINBERG
Title or Position: SR VP/GENERAL COUNSEL
Credential:
Phone: 214-736-2700