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General NPI Number Information
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NPI Number | 1750542213
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Entity Type | Organization
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Legal Business Name | USRC CANTON LLC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 400 E HWY 243 SUITE 14
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City | CANTON
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State | TX
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Zip | 75103-2445
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Country | US
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Telephone | 903-567-2250
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Fax | 903-567-2209
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Provider Business Mailing Address
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Address Line | PO BOX 19119
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City | JONESBORO
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State | AR
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Zip | 72403-6601
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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
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Name | 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 | 008728
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License Number State | TX
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