Healthcare Provider Details

I. General information

NPI: 1780686808
Provider Name (Legal Business Name): COLLEGE HEIGHTS ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 COLLEGE HEIGHTS BLVD
ALLENTOWN PA
18104-4813
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 610-841-2432
  • Fax: 610-841-4433
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number15861501
License Number StatePA

VIII. Authorized Official

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