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NPI Code Detail

MEDICARE: USRC TARRANT L P

MEDICARE: USRC TARRANT L P
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center008371TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2023058OTHERTXKIDNEY HEALTH CARE (KHC)
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4012033OTHERTXKIDNEY HEALTH CARE
5HH6454OTHERTXBLUE CROSS

General Provider Information

NPI Number : 1053367763
Entity Type Code : Organization
Provider Name (Legal Business Name) : USRC TARRANT L P
Provider Business Mailing Address
First Line : PO BOX 952074
Second Line :
City : DALLAS
State : TX
Zip : 75395-2074
Country : US
Telephone Number : 870-931-5400
Fax Number : 870-931-5418
Provider Business Practice Location Address
First Line : 1978 EPHRIHAM AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-6670
Country : US
Telephone Number : 817-624-7811
Fax Number : 817-624-6112
Authorized Official
Title or Position : VP, GENERAL COUNSEL
Name : MR. THOMAS L WEINBERG
Credential :
Telephone Number : 214-736-2700
Provider Enumeration Date : 05/25/2006
Last Update Date : 11/16/2023

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