Provider Demographics
NPI:1003272386
Name:TEDDIE JOE SNODGRASS, INC.
Entity Type:Organization
Organization Name:TEDDIE JOE SNODGRASS, INC.
Other - Org Name:SNODGRASS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEDDIE
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, DNP
Authorized Official - Phone:808-342-7843
Mailing Address - Street 1:105 FALLING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-3577
Mailing Address - Country:US
Mailing Address - Phone:808-342-7843
Mailing Address - Fax:866-323-1118
Practice Address - Street 1:1130 N NIMITZ HWY RM A153
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5777
Practice Address - Country:US
Practice Address - Phone:808-342-7843
Practice Address - Fax:866-323-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health