MEDICARE: SATELLITE DIALYSIS OF WHITE ROAD 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	:	1992204481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SATELLITE DIALYSIS OF WHITE ROAD 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	:	650-404-3600
Fax Number	:	650-404-3601

Provider Business Practice Location Address
First Line	:	3251 S WHITE RD STE 10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-4056
Country	:	US
Telephone Number	:	650-404-3600
Fax Number	:

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

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	05/15/2024

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