Basic Information
| Provider Information | |||||||||
| NPI: | 1275592636 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RENCARE LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDINA COUNTY DIALYSIS FACILITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3202 AVENUE G | ||||||||
| Address2: | |||||||||
| City: | HONDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788613522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8304263843 | ||||||||
| FaxNumber: | 8304262239 | ||||||||
| Practice Location | |||||||||
| Address1: | 3202 AVENUE G | ||||||||
| Address2: | |||||||||
| City: | HONDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788613522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8304263843 | ||||||||
| FaxNumber: | 8304262239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEINBERG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 9723676010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | US RENAL CARE INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 007311 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | HH6346 | 01 | TX | BCBS | OTHER | 002366 | 01 | TX | KIDNEY HEALTH CARE | OTHER |