=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427469634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SATELLITE HEALTHCARE CHICKASAW GARDENS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2014
-----------------------------------------------------
Last Update Date | 05/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2980 POPLAR AVENUE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38111-5637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-531-8850
-----------------------------------------------------
Fax | 650-625-6477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 SANTANA ROW SUITE 300
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-2423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-531-8850
-----------------------------------------------------
Fax | 650-625-6007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN
-----------------------------------------------------
Name | THOMAS L WEINBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-736-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------