Provider Demographics
NPI:1972838944
Name:SATELLITE DIALYSIS OF WHITE ROAD LLC
Entity Type:Organization
Organization Name:SATELLITE DIALYSIS OF WHITE ROAD LLC
Other - Org Name:SATELLITE HEALTHCARE WHITE ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL, PRESIDENT & CH
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 1:5851 LEGACY CIR STE 900
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5982
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:214-975-2435
Practice Address - Street 1:1450 S WHITE RD
Practice Address - Street 2:SUITE 30
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4798
Practice Address - Country:US
Practice Address - Phone:408-272-9810
Practice Address - Fax:408-272-9814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-08
Last Update Date:2023-11-06
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
CA550001276OtherSTATE OF CALIFORNIA
CA1972838944Medicaid
CA552652Medicare Oscar/Certification