Provider Demographics
NPI:1326282484
Name:SATELLITE DIALYSIS OF MERCED LLC
Entity Type:Organization
Organization Name:SATELLITE DIALYSIS OF MERCED LLC
Other - Org Name:SATELLITE HEALTHCARE MERCED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
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 1:300 SANTANA ROW
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2423
Mailing Address - Country:US
Mailing Address - Phone:209-383-7370
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:3376 N HIGHWAY 59
Practice Address - Street 2:STE I
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9411
Practice Address - Country:US
Practice Address - Phone:209-383-7370
Practice Address - Fax:209-726-3260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-20
Last Update Date:2024-05-02
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
CA1326282484Medicaid
CA550001236OtherSTATE OF CALIFORNIA
CA1326282484Medicaid