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General NPI Number Information
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NPI Number | 1669459079
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Entity Type | Organization
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Legal Business Name | USRC SAN BENITO DIALYSIS LTD
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 910 N MCCULLOUGH ST
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City | SAN BENITO
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State | TX
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Zip | 78586-0084
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Country | US
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Telephone | 956-399-4037
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Fax | 956-399-8119
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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 | SENIOR VICE-PRESIDENT/GENERAL COUNS
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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 | 008215
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License Number State | TX
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