Srs-Provo, Llc

LBN: Srs-Provo, Llc
Srs-Provo, Llc is an health care organization with primary practice located at 1675 N Freedom Blvd , Provo UT 84604-2540. The organization recently has only one registered license in Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment, which is considered as the primary health care specialty. Srs-Provo, Llc can be contacted via phone (888) 881-7854, or through Tannenbaum, Jerome via phone (615) 467-0140.

Contact Information

Primary practice address
1675 N Freedom Blvd Provo UT 84604-2540
Phone: (888) 881-7854
Fax: (885) 631-0206
Website:
Map and Directions
Authorized official contact:
Name: Tannenbaum, Jerome Doctor of Medicine (MD)
Phone: (615) 467-0140

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment 261QE0700X

Profile Details

NPI number 1679147904
LBN Legal business name Srs-Provo, Llc
DBA Doing business as
Authorized official Tannenbaum, Jerome Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 20th, 2021
Last updated May 21st, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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