Provider Demographics
NPI:1053367763
Name:USRC TARRANT L P
Entity type:Organization
Organization Name:USRC TARRANT L P
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, GENERAL COUNSEL
Authorized Official - Prefix:MR
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:PO BOX 952074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75395-2074
Mailing Address - Country:US
Mailing Address - Phone:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:1978 EPHRIHAM AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-6670
Practice Address - Country:US
Practice Address - Phone:817-624-7811
Practice Address - Fax:817-624-6112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008371261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189731601Medicaid
TX023058OtherKIDNEY HEALTH CARE (KHC)
TX189731602Medicaid
TX012033OtherKIDNEY HEALTH CARE
TXHH6454OtherBLUE CROSS
TX189731602Medicaid