MEDICARE: SRS-MEMPHIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1245834068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRS-MEMPHIS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 198813
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37219-8813
Country	:	US
Telephone Number	:	615-988-1060
Fax Number	:	855-631-0206

Provider Business Practice Location Address
First Line	:	7710 WOLF RIVER CIR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1734
Country	:	US
Telephone Number	:	615-988-7881
Fax Number	:	855-631-0206

Authorized Official
Title or Position	:	CEO
Name	:	DR. JEROME TANNENBAUM
Credential	:	MD
Telephone Number	:	615-467-0140

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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