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General NPI Number Information
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NPI Number | 1619944824
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Entity Type | Organization
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Legal Business Name | WAVERLEY SURGERY CENTER LLC
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 400 FOREST AVE
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City | PALO ALTO
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State | CA
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Zip | 94301-2608
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Country | US
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Telephone | 650-324-0600
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Fax | 650-289-1620
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Provider Business Mailing Address
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Address Line | 1A BURTON HILLS BLVD ATTN: L&C
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City | NASHVILLE
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State | TN
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Zip | 37215-6187
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Country | US
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Telephone | 615-240-3820
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Fax | 615-234-1720
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Authorized Official
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Title or Position | PRESIDENT OF LLC
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Name | MR. JEFFREY SNODGRASS
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Credential |
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Telephone | 615-263-4011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 220000472
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License Number State | CA
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