Provider Demographics
NPI:1225792997
Name:SRS-UTAH LLC
Entity Type:Organization
Organization Name:SRS-UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-754-7365
Mailing Address - Street 1:511 UNION ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2509
Mailing Address - Country:US
Mailing Address - Phone:615-499-5199
Mailing Address - Fax:615-259-0693
Practice Address - Street 1:511 UNION ST STE 1800
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219-2509
Practice Address - Country:US
Practice Address - Phone:615-499-5199
Practice Address - Fax:615-259-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment