Healthcare Provider Details

I. General information

NPI: 1043239338
Provider Name (Legal Business Name): NORTH VALLEY ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 N 40TH STREET BUILDING 8
PHOENIX AZ
85032
US

IV. Provider business mailing address

1A BURTON HILLS BLVD # L&C
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-1001
  • Fax:
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC3960
License Number StateAZ

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283