Provider Demographics
NPI:1336126804
Name:USRC EDINBURG LP
Entity Type:Organization
Organization Name:USRC EDINBURG LP
Other - Org Name:US RENAL CARE MISSION DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE-PRESIDENT/GENERAL COUNS
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
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 1:206 CONQUEST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4707
Practice Address - Country:US
Practice Address - Phone:956-383-8488
Practice Address - Fax:956-383-8489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-27
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008539261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177157802Medicaid
TX020319OtherKIDNEY HEALTH CARE
TX177157801Medicaid
TXHH6488OtherBLUE CROSS BLUE SHIELD
452890Medicare Oscar/Certification