Provider Demographics
NPI:1447439302
Name:USRC BRYAN ROAD DIALYSIS CENTER LLC
Entity type:Organization
Organization Name:USRC BRYAN ROAD DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR 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:972-367-6030
Mailing Address - Street 1:14651 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7476
Mailing Address - Country:US
Mailing Address - Phone:972-367-6010
Mailing Address - Fax:972-367-6011
Practice Address - Street 1:1300 S BRYAN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6626
Practice Address - Country:US
Practice Address - Phone:956-424-7833
Practice Address - Fax:956-424-7407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008626261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment