MEDICARE: WAKE ENDOSCOPY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1265379424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	1A BURTON HILLS BOULEVARD, SUITE 300
Second Line	:	ATTN: L&C
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 VETERANS PKWY STE 104
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-2760
Country	:	US
Telephone Number	:	919-341-3638
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY SNODGRASS
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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