MEDICARE: SATELLITE HEALTHCARE JAMESTOWN, 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	:	1386422947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SATELLITE HEALTHCARE JAMESTOWN, LLC

Provider Business Mailing Address
First Line	:	300 SANTANA ROW STE 300
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2424
Country	:	US
Telephone Number	:	650-404-3735
Fax Number	:

Provider Business Practice Location Address
First Line	:	18330 HIGHWAY 108
Second Line	:
City	:	JAMESTOWN
State	:	CA
Zip	:	95327-9615
Country	:	US
Telephone Number	:	209-532-3072
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY/GENERAL COUNSEL
Name	:	RYAN PARDO
Credential	:
Telephone Number	:	650-404-3600

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	09/15/2023

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