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NPI Code Detail

MEDICARE: CRYSTAL RIVER ENDOSCOPY ASC LP

MEDICARE: CRYSTAL RIVER ENDOSCOPY ASC LP
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
1261QA1903XAmbulatory Surgical Clinic/Center978FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952373086
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRYSTAL RIVER ENDOSCOPY ASC LP
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 : 6412 W GULF TO LAKE HWY
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-7622
Country : US
Telephone Number : 352-563-0223
Fax Number : 352-563-2961
Authorized Official
Title or Position : PRESIDENT
Name : MR. JEFFREY SNODGRASS
Credential :
Telephone Number : 615-665-1283
Provider Enumeration Date : 02/02/2006
Last Update Date : 10/31/2022

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1073558862 — DR. LAKSHMIPATHI R REDDI M.D.
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1649207036 — PAUL A HELLSTERN M.D.
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1063440139 — DR. PURNACHANDER R BIKKASANI M.D.
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Directions to “CRYSTAL RIVER ENDOSCOPY ASC LP ” Practice Location

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