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General NPI Number Information
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NPI Number | 1609847581
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Entity Type | Organization
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Legal Business Name | SATELLITE DIALYSIS-CENTRAL MODESTO LLC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 1315 10TH ST SUITE 300
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City | MODESTO
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State | CA
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Zip | 95354-0714
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Country | US
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Telephone | 209-238-4087
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Fax | 209-238-4092
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Provider Business Mailing Address
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Address Line | 5851 LEGACY CIR STE 900
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City | PLANO
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State | TX
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Zip | 75024-5982
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Country | US
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Telephone | 214-736-2700
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Fax | 214-975-2435
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL, PRESIDENT & CH
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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 | 110000527
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License Number State | CA
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