Basic Information
| Provider Information | |||||||||
| NPI: | 1447223938 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHATTANOOGA ENDOSCOPY ASC LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHATTANOOGA ENDOSCOPY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1A BURTON HILLS BLVD | ||||||||
| Address2: | ATTN: L&C | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152403741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 RIVERSIDE DRIVE | ||||||||
| Address2: | SUITE 117 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374064332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236983999 | ||||||||
| FaxNumber: | 4236980903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | SNODGRASS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 0000000098 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3288313 | 05 | TN | MEDICAID | 490004372 | 01 | TN | RAILROAD MEDICARE | OTHER |