MEDICARE: SATELLITE HEALTHCARE CENTRAL STATES 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	006777	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	008451	OTHER	TX	STATE OF TEXAS

General Provider Information

NPI Number	:	1861584211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SATELLITE HEALTHCARE CENTRAL STATES LLC

Provider Business Mailing Address
First Line	:	300 SANTANA ROW
Second Line	:	STE 300
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2423
Country	:	US
Telephone Number	:	512-977-0300
Fax Number	:	650-625-6007

Provider Business Practice Location Address
First Line	:	10000 METRIC BLVD
Second Line	:	STE 100
City	:	AUSTIN
State	:	TX
Zip	:	78758-5210
Country	:	US
Telephone Number	:	512-977-0300
Fax Number	:	512-833-8488

Authorized Official
Title or Position	:	CEO
Name	:	SUSAN L DEL BENE
Credential	:
Telephone Number	:	650-404-3618

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	12/30/2016

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