=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992785232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST FLORIDA A S C LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2006
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204B E 19TH ST
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32405-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-769-7599
-----------------------------------------------------
Fax | 850-769-7389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1A BURTON HILLS BLVD STE 300
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37215-6153
-----------------------------------------------------
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 | 952
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------