Provider Demographics
NPI:1669459079
Name:USRC SAN BENITO DIALYSIS LTD
Entity Type:Organization
Organization Name:USRC SAN BENITO DIALYSIS LTD
Other - Org Name:US RENAL CARE SAN BENITO DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE-PRESIDENT/GENERAL COUNS
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 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 1:910 N MCCULLOUGH ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-0084
Practice Address - Country:US
Practice Address - Phone:956-399-4037
Practice Address - Fax:956-399-8119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-28
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008215261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176515802Medicaid
TXHH043YOtherBCBS
TX018885OtherKIDNEY HEALTH CARE
TX176515801Medicaid
672514Medicare Oscar/Certification