Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Srs-Provo, LLC

Organization End-Stage Renal Disease (ESRD) Treatment Clinic/Center · NPI 1679147904

Srs-Provo, LLC is an End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Provo, Utah. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1675 N Freedom Blvd
Provo, UT 84604-2540
Phone: (888) 881-7854
Fax: (885) 631-0206
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

End-Stage Renal Disease (ESRD) Treatment Clinic/Center (primary) Taxonomy 261QE0700X

Record details

NPI number1679147904
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jerome Tannenbaum — Ceo And Chairman Of The Board · (615) 467-0140
NPI enumeratedMay 20, 2021
Last updated in NPPESMay 21, 2021
Certification dateMay 21, 2021
Mailing addressPo Box 198813, Nashville, TN 37219-8813

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