Healthcare Provider Details

I. General information

NPI: 1386614832
Provider Name (Legal Business Name): CARROLL COUNTY DIGESTIVE DISEASE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216B WASHINGTON HEIGHTS MED CTR
WESTMINSTER MD
21157-5633
US

IV. Provider business mailing address

1A BURTON HILLS BLVD # L&C
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 410-857-5113
  • Fax: 410-840-8344
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberA1245
License Number StateMD

VIII. Authorized Official

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