MEDICARE: EASTERN CONNECTICUT 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
2	261QE0800X	Endoscopy Clinic/Center	0295	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	490004614	OTHER	CT	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2373165	OTHER	AETNA PHMO POS
2	351	OTHER	BCBS FEDERAL
4	2373165	OTHER	AETNA PPO EPO NAP MC
5	765560	OTHER	CONNECTICARE
6	351	OTHER	BCBS CT
7	351	OTHER	NBC NATIONAL
8	A2114853	OTHER	OXFORD
9	IV9845	OTHER	HEALTH NET
10	2373165	OTHER	USHC AETNA US HEALTH CARE

General Provider Information

NPI Number	:	1609864883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN CONNECTICUT ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	1A BURTON HILLS BLVD # L&C
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6187
Country	:	US
Telephone Number	:	615-240-3820
Fax Number	:	615-234-1720

Provider Business Practice Location Address
First Line	:	79 WAWECUS ST
Second Line	:	SUITE 107
City	:	NORWICH
State	:	CT
Zip	:	06360-2160
Country	:	US
Telephone Number	:	860-886-7800
Fax Number	:	860-886-7808

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/09/2022

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