=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962400044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COA ASC OF FRANKLIN COUNTY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 11/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5965 E BROAD ST SUITE 460
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213-1562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-751-4080
-----------------------------------------------------
Fax | 614-751-4092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1A BURTON HILLS BLVD # L&C
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37215-6187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-665-1283
-----------------------------------------------------
Fax | 615-234-1720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JEFFREY E. 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 | 0010AS
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------