Organization
SRS- KIRKSVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME SEYMOUR TANNENBAUM (PRESIDENT)
(615) 467-0140
Entity
Organization
Contact information
Practice address
315 S OSTEOPATHY AVE, KIRKSVILLE, MO 63501-6401
(615) 467-0140
(615) 259-0693
Mailing address
511 UNION ST, SUITE 1800, NASHVILLE, TN 37219-1733
(615) 467-0140
(615) 259-0693
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2014
Last updated
01/19/2015
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