Healthcare Provider Details

I. General information

NPI: 1679816342
Provider Name (Legal Business Name): OAK LAWN IL ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 SOUTHWEST HWY
OAK LAWN IL
60453-3767
US

IV. Provider business mailing address

1A BURTON HILLS BLVD
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-2552
  • Fax: 708-425-9606
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 Number
License Number StateIL

VIII. Authorized Official

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