Provider Demographics
NPI:1922070283
Name:BRIGGSMORE KIDNEY CENTER, LLC
Entity Type:Organization
Organization Name:BRIGGSMORE KIDNEY CENTER, LLC
Other - Org Name:U.S. RENAL CARE PARKWAY DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
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 749131
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9131
Mailing Address - Country:US
Mailing Address - Phone:562-495-8075
Mailing Address - Fax:562-495-8076
Practice Address - Street 1:2200 PLAZA PKWY
Practice Address - Street 2:STE B1-B4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6222
Practice Address - Country:US
Practice Address - Phone:209-574-6818
Practice Address - Fax:209-574-6816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-02
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000499261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02888FMedicaid
CACDC02888FMedicaid