Healthcare Provider Details

I. General information

NPI: 1134300080
Provider Name (Legal Business Name): METAIRIE LA ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD STE 520
METAIRIE LA
70006-3016
US

IV. Provider business mailing address

1A BURTON HILLS BLVD # L&C
NASHVILLE TN
37215-6100
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-3345
  • Fax: 504-885-3349
Mailing address:
  • Phone: 615-665-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number149
License Number StateLA

VIII. Authorized Official

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