1568418143 NPI number — USRC TARRANT L P

Table of content: (NPI 1568418143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568418143 NPI number — USRC TARRANT L P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USRC TARRANT L P
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:
1568418143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 952074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75395-0001
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:
12201 BEAR PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-0285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-293-1978
Provider Business Practice Location Address Fax Number:
817-568-1603
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VP, GENERAL COUNSEL
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  08465 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0700X , with the licence number: 110071 , 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: 186431608 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001429 . This is a "KIDNEY HEALTH CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 186431609 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH6167 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 023030 . This is a "KIDNEY HEALTH CARE (KHC)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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