Healthcare Provider Details

I. General information

NPI: 1619065273
Provider Name (Legal Business Name): SHENANDOAH TX ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VISION PARK BLVD STE 160
SHENANDOAH TX
77384-3005
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 936-321-8910
  • Fax: 936-321-8913
Mailing address:
  • Phone: 615-665-1283
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number008420
License Number StateTX

VIII. Authorized Official

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