1336126804 NPI number — USRC EDINBURG LP

Table of content: (NPI 1336126804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336126804 NPI number — USRC EDINBURG LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USRC EDINBURG LP
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:
Provider Other Organization Name Type Code:
6
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:
1336126804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72403-6601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-931-5400
Provider Business Mailing Address Fax Number:
870-931-5418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 CONQUEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-383-8488
Provider Business Practice Location Address Fax Number:
956-383-8489
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE-PRESIDENT/GENERAL COUNS
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  008539 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 177157802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020319 . This is a "KIDNEY HEALTH CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 177157801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH6488 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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