Healthcare Provider Details

I. General information

NPI: 1043282775
Provider Name (Legal Business Name): BALTIMORE ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GEIPE RD STE 220
BALTIMORE MD
21228-4577
US

IV. Provider business mailing address

1A BURTON HILLS BLVD # 300L&C
NASHVILLE TN
37215-6100
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-3636
  • Fax: 410-242-4404
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1160
License Number StateMD

VIII. Authorized Official

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