MEDICARE: USRC COLLEGE PARTNERSHIP LP

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	008624	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

General Provider Information

NPI Number	:	1427259399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USRC COLLEGE PARTNERSHIP LP

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	:	6120 SCOTT ST
Second Line	:	STE F
City	:	HOUSTON
State	:	TX
Zip	:	77021-2698
Country	:	US
Telephone Number	:	713-741-7059
Fax Number	:	713-751-4320

Authorized Official
Title or Position	:	VP GENERAL COUNSEL
Name	:	THOMAS L WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	10/28/2013

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