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SRS-PROVO, LLC
NPI 1679147904
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Provo, UT

Active since May 20, 2021
1675 N FREEDOM BLVD, PROVO, UT 84604(888) 881-7854(885) 631-0206 Get Directions Write a Review

NPPES record last updated: May 21, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Srs-provo, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SRS-PROVO, LLC (NPI 1679147904) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Provo, Utah and active in the NPI registry since May 2021. The organization lists Jerome Tannenbaum, Ceo And Chairman Of The Board, as its authorized official.

NPPES Registry Identity

NPI1679147904
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameSRS-PROVO, LLC
Location Address1675 N FREEDOM BLVDProvo, UT 84604-2540
Mailing AddressPo Box 198813Nashville, TN 37219-8813 · (615) 988-1060 · Fax (855) 631-0206
Phone(888) 881-7854
Fax(885) 631-0206
Organization SubpartNo
Authorized OfficialJerome TannenbaumCeo And Chairman Of The Board · (615) 467-0140
Enumeration DateMay 20, 2021
Last NPPES UpdateMay 21, 2021
NPPES CertifiedMay 21, 2021
✔ NPI 1679147904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
1675 N FREEDOM BLVD, Provo, UT 84604
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Utah, University of Utah Health Plans.Insurance ›

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MATTHEW JOSEPH CLAYTON D.O.
Pediatrics
1675 N FREEDOM BLVD, STE 9C
PROVO, UT 84604
Utah County (801) 377-4800
NEW HORIZON WOMEN'S CARE, LLC
Internal Medicine
1675 N FREEDOM BLVD, SUITE 3
PROVO, UT 84604
Utah County (801) 374-1010
PROVO DIALYSIS CENTER UNIVERSITY OF UTAH
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1675 N FREEDOM BLVD
PROVO, UT 84604
Utah County (801) 373-0167
TOTAL RENAL CARE INC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1675 N FREEDOM BLVD
PROVO, UT 84604
Utah County (801) 373-0169
DR. DAMON MONSON FAUST D.C.
Chiropractor
1675 N FREEDOM BLVD, 7A
PROVO, UT 84604
Utah County (801) 489-1075
KENT BLAD FNP
Nurse Practitioner (Pediatrics)
1675 N FREEDOM BLVD, BLDG 3
PROVO, UT 84604
Utah County (801) 377-8000
DR. DARREN WESLEY GARDNER DDS
Dentist (General Practice)
1675 N FREEDOM BLVD, STE 12A
PROVO, UT 84604
Utah County (801) 374-8970
COURTNEY CARLTON CSW
Social Worker (Clinical)
1675 N FREEDOM BLVD
PROVO, UT 84604
Utah County (385) 225-4904

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Srs-Provo, LLC's NPI number?

The NPI number for Srs-Provo, LLC is 1679147904. It was assigned to this organization in the NPPES registry on May 20, 2021.

Where is Srs-Provo, LLC located?

Srs-Provo, LLC is located at 1675 N Freedom Blvd, Provo, UT 84604. The listed phone number is (888) 881-7854.

What is Srs-Provo, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

What insurance does Srs-Provo, LLC accept?

Health plans from BridgeSpan Health Company, Regence BlueCross BlueShield of Utah and University of Utah Health Plans list Srs-Provo, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Srs-Provo, LLC was last updated on May 21, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.