Provider Demographics
NPI:1457310880
Name:USRC SA BANDERA ROAD LLC
Entity Type:Organization
Organization Name:USRC SA BANDERA ROAD LLC
Other - Org Name:US RENAL CARE BANDERA ROAD DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, GENERAL COUNSEL
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:214-736-2730
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:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:7831 WESTCHASE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2976
Practice Address - Country:US
Practice Address - Phone:210-682-1300
Practice Address - Fax:210-682-1316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008087261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168304702Medicaid
TX017403OtherKIDNEY HEALTH CARE
TXHH6474OtherBCBS
TX017403OtherKIDNEY HEALTH CARE
TX017403OtherKIDNEY HEALTH CARE