OrganizationActive
Srs-Provo, LLC
NPI 1679147904 · End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Provo, UT
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
Practice location
1675 N Freedom Blvd
Provo, UT 84604-2540
Phone: (888) 881-7854
Fax: (885) 631-0206
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 198813
Nashville, TN 37219-8813
Registry dates
- Enumerated
- 2021-05-20
- Last updated
- 2021-05-21
- Certified
- 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.