Organization · Type 2 NPI

Srs-Provo, LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Provo, UT

NPI number 1679147904 Active

Practice location

1675 N Freedom Blvd
Provo, UT 84604-2540

Call (888) 881-7854 Map

Fax (885) 631-0206

Mailing address

PO Box 198813
Nashville, TN 37219-8813

Specialties and licenses

TaxonomyCodeLicense
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary 261QE0700XNone listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

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About NPI 1679147904

Srs-Provo, LLC's National Provider Identifier is 1679147904, issued on May 20, 2021. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Provo, UT. The record was last updated on May 21, 2021.