Srs-Provo, LLC
NPI 1679147904 · End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Provo, UT
Enrolled with Medicare as Part a Provider - End-Stage Renal Disease Facility (esrd) · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Srs-Provo, LLC is a End-Stage Renal Disease (ESRD) Treatment Clinic/Center organization in Provo, UT (NPI 1679147904).
Provider details
- NPI number
- 1679147904
- Entity type
- Organization
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jerome Tannenbaum, Ceo and Chairman of the Board(615) 467-0140
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2021-05-20
- Last updated
- 2021-05-21
- Certified
- 2021-05-21
Frequently asked questions
- What is Srs-Provo, LLC's NPI number?
- Srs-Provo, LLC's National Provider Identifier (NPI) is 1679147904, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Srs-Provo, LLC?
- Srs-Provo, LLC is classified in the NPPES registry as End-Stage Renal Disease (ESRD) Treatment Clinic/Center (Ambulatory Health Care Facilities).
- Where is Srs-Provo, LLC located?
- Srs-Provo, LLC's practice location on file with NPPES is 1675 N Freedom Blvd, Provo, UT 84604-2540.
- What is Srs-Provo, LLC's phone number?
- The practice phone number listed in the NPPES registry for Srs-Provo, LLC is (888) 881-7854.
- Does Srs-Provo, LLC accept Medicare?
- Srs-Provo, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Srs-Provo, LLC?
- The authorized official listed on Srs-Provo, LLC's NPPES record is Jerome Tannenbaum, Ceo and Chairman of the Board. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Srs-Provo, LLC's NPI active?
- Yes — Srs-Provo, LLC's NPI (1679147904) is active in the NPPES registry as of the last update on 2021-05-21.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.