Provider Demographics
NPI:1093098550
Name:DIALYSIS NEWCO LLC
Entity Type:Organization
Organization Name:DIALYSIS NEWCO LLC
Other - Org Name:U.S. RENAL CARE SOUTHWEST MESA 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:PO BOX 251549
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1500
Mailing Address - Country:US
Mailing Address - Phone:615-234-1188
Mailing Address - Fax:615-234-9526
Practice Address - Street 1:1457 W SOUTHERN AVE
Practice Address - Street 2:SUITE D-19
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4813
Practice Address - Country:US
Practice Address - Phone:480-894-5411
Practice Address - Fax:480-894-2607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3850261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ032526Medicare Oscar/Certification