Provider Demographics
NPI:1104200757
Name:USRC BOYNTON BEACH, LLC
Entity Type:Organization
Organization Name:USRC BOYNTON BEACH, LLC
Other - Org Name:U.S. RENAL CARE BOYNTON BEACH DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
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:214-736-2730
Mailing Address - Street 1:5851 LEGACY CIR
Mailing Address - Street 2:SUITE 900
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5966
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:214-736-2701
Practice Address - Street 1:1500 GATEWAY BLVD
Practice Address - Street 2:STE 190
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7219
Practice Address - Country:US
Practice Address - Phone:561-734-1184
Practice Address - Fax:561-735-9879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-14
Last Update Date:2016-12-09
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
FL682589Medicare Oscar/Certification