Provider Demographics
NPI:1073682159
Name:CENTRAL MASSACHUSETTS AMBULATORY ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:CENTRAL MASSACHUSETTS AMBULATORY ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
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:615-240-3820
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:105 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1805
Practice Address - Country:US
Practice Address - Phone:978-840-6767
Practice Address - Fax:978-840-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAQA3261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854127Medicaid
3644952OtherAETNA
621501OtherTUFTS
2952966OtherCIGNA
90346OtherFALLON
907577OtherHPHC
M88031OtherBCBS
MA221045Medicare PIN
M88031OtherBCBS