Provider Demographics
NPI:1083677587
Name:DCA OF MECHANICSBURG LLC
Entity Type:Organization
Organization Name:DCA OF MECHANICSBURG LLC
Other - Org Name:U S RENAL CARE MECHANICSBURG DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:MR
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:PO BOX 19119
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6601
Mailing Address - Country:US
Mailing Address - Phone:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:120 S FILBERT ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6539
Practice Address - Country:US
Practice Address - Phone:717-790-6080
Practice Address - Fax:717-790-6081
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U S RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2018-06-21
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
PAPPA01604OtherPA CHRONIC RENAL
PA01888760OtherUNISON
PA0018887600001Medicaid
PA7278046OtherAETNA
PA2687877OtherAETNA
PA907109OtherTUFTS HEALTH PLAN
PA1522940OtherGATEWAY
PA1852OtherPA HIGHMARK
PA20012167OtherAMERIHEALTH MERCY
PA7287332OtherAETNA US HEALTHCARE
PAPPA01604OtherPA CHRONIC RENAL