Provider Demographics
NPI:1003887225
Name:CENTRAL TEXAS ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:CENTRAL TEXAS ENDOSCOPY CENTER LLC
Other - Org Name:CENTRAL TEXAS ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD # L&C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-665-1283
Mailing Address - Fax:
Practice Address - Street 1:2206 E. VILLA MARIA
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2547
Practice Address - Country:US
Practice Address - Phone:979-774-4211
Practice Address - Fax:979-774-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
TX007156261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087979301Medicaid
TX490004647OtherMEDICARE RAILROAD
TX0879793-01Medicaid
TXHH1520OtherBLUE CROSS BLUE SHIELD
TX490004647OtherMEDICARE RAILROAD
45C0001265Medicare PIN
TXASC079Medicare PIN