1467816504 NPI number — USRC ROWLETT, LLC

Table of content: (NPI 1467816504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467816504 NPI number — USRC ROWLETT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USRC ROWLETT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
US RENAL CARE ROWLETT DIALYSIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467816504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-736-2700
Provider Business Mailing Address Fax Number:
214-736-2790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 LAKEVIEW PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ROWLETT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75088-4355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-412-1631
Provider Business Practice Location Address Fax Number:
972-412-1713
Provider Enumeration Date:
04/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com