Provider Demographics
NPI:1568418143
Name:USRC TARRANT L P
Entity Type:Organization
Organization Name:USRC TARRANT L P
Other - Org Name:US RENAL CARE TARRANT DIALYSIS SOUTH FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, GENERAL COUNSEL
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:214-736-2700
Mailing Address - Street 1:PO BOX 952074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75395-0001
Mailing Address - Country:US
Mailing Address - Phone:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:12201 BEAR PLAZA
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0285
Practice Address - Country:US
Practice Address - Phone:817-293-1978
Practice Address - Fax:817-568-1603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08465261QE0700X
TX110071261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186431608Medicaid
TX001429OtherKIDNEY HEALTH CARE
TX186431609Medicaid
TXHH6167OtherBLUE CROSS
TX023030OtherKIDNEY HEALTH CARE (KHC)
TXHH6167OtherBLUE CROSS