Provider Demographics
NPI:1568037786
Name:SRS-WEBER VALLEY, LLC
Entity Type:Organization
Organization Name:SRS-WEBER VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
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:615-467-0140
Mailing Address - Street 1:PO BOX 198813
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-8813
Mailing Address - Country:US
Mailing Address - Phone:615-988-7881
Mailing Address - Fax:855-631-0206
Practice Address - Street 1:1920 W 250 N
Practice Address - Street 2:
Practice Address - City:MARRIOTT SLATERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-9233
Practice Address - Country:US
Practice Address - Phone:888-883-0265
Practice Address - Fax:855-631-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment