Healthcare Provider Details

I. General information

NPI: 1164105599
Provider Name (Legal Business Name): CLOVIS ENDOSCOPY ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-9211
US

IV. Provider business mailing address

1A BURTON HILLS BLVD STE 300
NASHVILLE TN
37215-6153
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-9290
  • Fax: 615-234-1720
Mailing address:
  • Phone: 615-263-4011
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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