=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073682159
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL MASSACHUSETTS AMBULATORY ENDOSCOPY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 09/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 ERDMAN WAY
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-840-6767
-----------------------------------------------------
Fax | 978-840-6766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1A BURTON HILLS BLVD # L&C
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37215-6187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-240-3820
-----------------------------------------------------
Fax | 615-234-1720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JEFFREY SNODGRASS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-665-1283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | AQA3
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------