Provider Demographics
NPI:1164794715
Name:SATELLITE DIALYSIS OF OAKLAND LLC
Entity type:Organization
Organization Name:SATELLITE DIALYSIS OF OAKLAND 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:214-726-2700
Mailing Address - Street 1:5851 LEGACY CIR STE 900
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5982
Mailing Address - Country:US
Mailing Address - Phone:650-404-3600
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:255 2ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4307
Practice Address - Country:US
Practice Address - Phone:510-433-8340
Practice Address - Fax:510-547-1444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-29
Last Update Date:2024-07-29
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
CA1164794715Medicaid
CA550002213OtherSTATE LICENSE
CA552717Medicare Oscar/Certification