Healthcare Provider Details

I. General information

NPI: 1932524683
Provider Name (Legal Business Name): SRS - TEHACHAPI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 VALLEY BLVD
TEHACHAPI CA
93561-2119
US

IV. Provider business mailing address

PO BOX 198813
NASHVILLE TN
37219-8813
US

V. Phone/Fax

Practice location:
  • Phone: 615-467-0140
  • Fax: 615-259-0693
Mailing address:
  • Phone: 615-467-0140
  • Fax: 615-259-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEROME S TANNENBAUM
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 615-467-0140