Healthcare Provider Details

I. General information

NPI: 1194718056
Provider Name (Legal Business Name): MARIN ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S ELISEO DR SUITE 3
GREENBRAE CA
94904-2017
US

IV. Provider business mailing address

1100 S ELISEO DR SUITE 3
GREENBRAE CA
94904-2017
US

V. Phone/Fax

Practice location:
  • Phone: 415-464-0606
  • Fax: 416-464-0644
Mailing address:
  • Phone: 415-464-0606
  • Fax: 416-464-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number110000421
License Number StateCA

VIII. Authorized Official

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