Healthcare Provider Details

I. General information

NPI: 1053496240
Provider Name (Legal Business Name): OAKLAND CA ENDOSCOPY ASC LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FRANK OGAWA PLAZA SUITE 135
OAKLAND CA
94612
US

IV. Provider business mailing address

3300 WEBSTER ST SUITE 312
OAKLAND CA
94609-3117
US

V. Phone/Fax

Practice location:
  • Phone: 510-893-1600
  • Fax:
Mailing address:
  • Phone: 510-893-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number140000674
License Number StateCA

VIII. Authorized Official

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