Provider Demographics
NPI:1831483270
Name:RENAL CENTER OF PLANO, LLC
Entity Type:Organization
Organization Name:RENAL CENTER OF PLANO, LLC
Other - Org Name:RENAL CENTER OF PLANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-733-4501
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L&C DEPARTMENT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-997-4210
Mailing Address - Fax:866-935-5481
Practice Address - Street 1:4112 W SPRING CREEK PKWY STE D200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5210
Practice Address - Country:US
Practice Address - Phone:972-608-7831
Practice Address - Fax:972-608-7837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL CENTER OF PLANO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110080261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324409701Medicaid
TX324409701Medicaid