Provider Demographics
NPI:1821013657
Name:US RENAL CARE BOERNE LLC
Entity type:Organization
Organization Name:US RENAL CARE BOERNE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
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:PO BOX 19119
Mailing Address - Street 2:SUITE 350
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6601
Mailing Address - Country:US
Mailing Address - Phone:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:1595 S MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3329
Practice Address - Country:US
Practice Address - Phone:830-816-3030
Practice Address - Fax:830-816-3038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2013-01-23
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
TX186101502Medicaid
TX021309OtherKIDNEY HEALTH CARE
TX186101501Medicaid
TXHH076YOtherBCBS
TX186101502Medicaid