Provider Demographics
NPI:1083660617
Name:EL PASO KIDNEY CENTER EAST LTD
Entity Type:Organization
Organization Name:EL PASO KIDNEY CENTER EAST LTD
Other - Org Name:U.S. RENAL CARE EAST EL PASO DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
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 1:424 CHURCH ST
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2301
Mailing Address - Country:US
Mailing Address - Phone:615-234-1188
Mailing Address - Fax:615-234-9526
Practice Address - Street 1:10737 GATEWAY BLVD W
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4920
Practice Address - Country:US
Practice Address - Phone:915-590-8334
Practice Address - Fax:915-590-9051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2016-03-29
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
TX1910234-02Medicaid
TX1910234-02Medicaid