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General NPI Number Information
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NPI Number | 1669657805
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Entity Type | Organization
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Legal Business Name | MODESTO KIDNEY CENTER, LLC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 305 E GRANGER AVE STE 102
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City | MODESTO
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State | CA
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Zip | 95350-4344
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Country | US
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Telephone | 209-574-6800
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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 | 214-736-2700
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Fax | 214-736-2790
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Authorized Official
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Title or Position | CHAIRMAN & PRESIDENT
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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 | 110000468
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License Number State | CA
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