Healthcare Provider Details

I. General information

NPI: 1497720999
Provider Name (Legal Business Name): LAKE BLUFF IL ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WAUKEGAN RD SUITE 980
LAKE BLUFF IL
60044-3012
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 847-604-8700
  • Fax: 847-604-8711
Mailing address:
  • Phone: 615-240-3741
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002926
License Number StateIL

VIII. Authorized Official

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