Provider Demographics
NPI:1073910600
Name:USRC PETERSBURG, LLC
Entity Type:Organization
Organization Name:USRC PETERSBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:2400 DALLAS PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4370
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:
Practice Address - Street 1:1964 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2716
Practice Address - Country:US
Practice Address - Phone:804-733-3847
Practice Address - Fax:804-733-3530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA492684Medicare Oscar/Certification