Provider Demographics
NPI:1689980419
Name:USRC EAST FT WORTH LLC
Entity Type:Organization
Organization Name:USRC EAST FT WORTH LLC
Other - Org Name:U.S. RENAL CARE EAST FORT WORTH DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
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: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 1:6450 BRENTWOOD STAIR RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3239
Practice Address - Country:US
Practice Address - Phone:817-888-3015
Practice Address - Fax:817-888-3021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-31
Last Update Date:2022-05-25
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
672705Medicare Oscar/Certification