MEDICARE: USRC WEST UNIVERSITY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1033503479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USRC WEST UNIVERSITY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 19119
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72403-6601
Country	:	US
Telephone Number	:	870-831-5400
Fax Number	:	870-931-5418

Provider Business Practice Location Address
First Line	:	9219 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3902
Country	:	US
Telephone Number	:	713-349-0724
Fax Number	:	713-349-0739

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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