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General NPI Number Information
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NPI Number | 1023064623
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Entity Type | Organization
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Legal Business Name | USRC SW FT WORTH LLC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 5127 OLD GRANBURY RD
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City | FORT WORTH
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State | TX
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Zip | 76133-2017
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Country | US
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Telephone | 817-370-7830
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Fax | 817-370-1927
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Provider Business Mailing Address
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Address Line | PO BOX 251549
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City | PLANO
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State | TX
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Zip | 75025-1500
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Country | US
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Telephone | 870-931-5400
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Fax | 870-931-5418
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Authorized Official
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Title or Position | VICE-PRESIDENT AND GENERAL COUNSEL
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Name | MR. THOMAS L WEINBERG
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Credential |
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Telephone | 214-736-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 008443
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License Number State | TX
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