MEDICARE: USRC HILO, 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	:	1366162588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USRC HILO, LLC

Provider Business Mailing Address
First Line	:	5851 LEGACY CIR STE 900
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5982
Country	:	US
Telephone Number	:	214-736-2700
Fax Number	:	214-975-2435

Provider Business Practice Location Address
First Line	:	111 E PUAINAKO ST STE 655
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-5278
Country	:	US
Telephone Number	:	808-909-3996
Fax Number	:	808-909-3935

Authorized Official
Title or Position	:	PRESIDENT AND CHAIRMAN
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	07/13/2023

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