Provider Demographics
NPI:1841385630
Name:SATELLITE HEALTHCARE CENTRAL STATES LLC
Entity Type:Organization
Organization Name:SATELLITE HEALTHCARE CENTRAL STATES LLC
Other - Org Name:SATELLITE HEALTHCARE ROUND ROCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEL BENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-3618
Mailing Address - Street 1:300 SANTANA ROW
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2423
Mailing Address - Country:US
Mailing Address - Phone:512-275-0100
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:16010 PARK VALLEY DR
Practice Address - Street 2:STE 100
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3575
Practice Address - Country:US
Practice Address - Phone:512-275-0100
Practice Address - Fax:512-388-6025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008035261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008459OtherSTATE OF TEXAS
TX185969604Medicaid
TX452881Medicare Oscar/Certification