Provider Demographics
NPI:1932294725
Name:SATELLITE HEALTHCARE CENTRAL STATES LLC
Entity Type:Organization
Organization Name:SATELLITE HEALTHCARE CENTRAL STATES LLC
Other - Org Name:SATELLITE HEALTHCARE KYLE
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:640-404-3618
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:512-268-3100
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:134 ELMHURST DRIVE
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6060
Practice Address - Country:US
Practice Address - Phone:512-392-9199
Practice Address - Fax:512-392-9363
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
TX008452261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185969602Medicaid
TX110096OtherSTATE OF TEXAS
TX452788Medicare Oscar/Certification