Healthcare Provider Details

I. General information

NPI: 1265379424
Provider Name (Legal Business Name): WAKE ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VETERANS PKWY STE 104
CLAYTON NC
27520-2760
US

IV. Provider business mailing address

1A BURTON HILLS BOULEVARD, SUITE 300 ATTN: L&C
NASHVILLE TN
37215-6153
US

V. Phone/Fax

Practice location:
  • Phone: 919-341-3638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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