=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427525385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USRC HILL COUNTRY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2018
-----------------------------------------------------
Last Update Date | 10/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12011 STATE HWY 151
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-248-1110
-----------------------------------------------------
Fax | 210-248-1111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 251549
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75025-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-736-2700
-----------------------------------------------------
Fax | 214-975-2435
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------