SRS-PROVO LLC NPI 1679147904

NPI Information

  • NPI: 1679147904
  • Provider Name: SRS-PROVO, LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Address: 1675 N FREEDOM BLVD
    PROVO, UT
    ZIP 84604
  • Phone: (888) 881-7854

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NPI Details

SRS-PROVO, LLC is an end-stage renal disease (esrd) treatment clinic center in Provo, UT. SRS-PROVO, LLC NPI is 1679147904. The provider is registered as an organization entity type.

The provider's business location address is:

1675 N FREEDOM BLVD
PROVO, UT
ZIP 84604-540
Phone: (888) 881-7854
Fax: (885) 631-0206

The provider's authorized official is Jerome Tannenbaum .
The authorized official title is Ceo And Chairman Of The Board and has the following contact phone number (615) 467-0140.

The enumeration date for this NPI number is 5/20/2021 and was last updated on 5/21/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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