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General NPI Number Information
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NPI Number | 1306495502
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Entity Type | Organization
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Legal Business Name | USRC ELLISVILLE LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 257 CLARKSON RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2219
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Country | US
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Telephone | 637-207-7401
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Fax |
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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 |
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | THOMAS L WEINBERG
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Credential |
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Telephone | 214-736-2730
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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 |
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License Number State |
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