Provider Demographics
NPI:1871729590
Name:SATELLITE HEALTHCARE OF PACE ROAD LLC
Entity type:Organization
Organization Name:SATELLITE HEALTHCARE OF PACE ROAD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
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 1:300 SANTANA ROW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2423
Mailing Address - Country:US
Mailing Address - Phone:901-345-8649
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:4185 PACE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-5871
Practice Address - Country:US
Practice Address - Phone:901-345-8649
Practice Address - Fax:901-345-1013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-09
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
44D1104889OtherCLIA
TN0000000193OtherSTATE OF TENNESSEE DEPARTMENT OF HEALTH
TN1518692Medicaid
44D1104889OtherCLIA