MEDICARE: USRC RIO GRANDE 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	008202	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	020159	OTHER	TX	KIDNEY HEALTH CARE
4	HH6489	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1346227824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USRC RIO GRANDE LLC

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

Provider Business Practice Location Address
First Line	:	2787 PHARMACY RD
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6201
Country	:	US
Telephone Number	:	956-487-2929
Fax Number	:	956-487-4673

Authorized Official
Title or Position	:	SENIOR VICE-PRESIDENT/GENERAL COUNS
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	09/21/2023

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Directions to “USRC RIO GRANDE LLC ” Practice Location

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