Organization
SRS-AMERICAN FORK, LLC
Active
Other names
SRS Dialysis of American Fork
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME S TANNENBAUM MD (CEO AND CHAIRMAN OF THE BOARD)
(615) 467-0140
Entity
Organization
Contact information
Practice address
1159 E 200 N, AMERICAN FORK, UT 84003-2022
(888) 893-7783
(855) 631-0206
Mailing address
PO BOX 198813, NASHVILLE, TN 37219-8813
(615) 988-7881
(855) 631-0206
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
05/20/2021
Last updated
05/21/2021
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