Healthcare Provider Details

I. General information

NPI: 1457968430
Provider Name (Legal Business Name): PARK VENTURA ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 STATE HIGHWAY 121 STE 2100
ALLEN TX
75013-6148
US

IV. Provider business mailing address

1A BURTON HILLS BLVD STE 300
NASHVILLE TN
37215-6153
US

V. Phone/Fax

Practice location:
  • Phone: 214-383-8210
  • Fax: 972-985-2320
Mailing address:
  • Phone: 615-240-3741
  • Fax: 615-234-1720

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