Provider Demographics
NPI:1679016786
Name:SRS - RAMONA LLC
Entity Type:Organization
Organization Name:SRS - RAMONA LLC
Other - Org Name:SANDERLING DIALYSIS OF RAMONA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-467-0140
Mailing Address - Street 1:511 UNION ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1733
Mailing Address - Country:US
Mailing Address - Phone:615-499-5119
Mailing Address - Fax:
Practice Address - Street 1:2102 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2519
Practice Address - Country:US
Practice Address - Phone:615-499-5119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment