Basic Information
| Provider Information | |||||||||
| NPI: | 1710554571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USRC PEARLRIDGE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5851 LEGACY CIR STE 900 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750245982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147362700 | ||||||||
| FaxNumber: | 2149752435 | ||||||||
| Practice Location | |||||||||
| Address1: | 98-1005 MOANALUA RD SPC 420 | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084404800 | ||||||||
| FaxNumber: | 8084851060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | WEINBERG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN AND PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2147362700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U.S. RENAL CARE, INC. | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.