Provider Demographics
NPI:1114996774
Name:REDBIRD SQUARE ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:REDBIRD SQUARE ENDOSCOPY CENTER LLC
Other - Org Name:DIGESTIVE HEALTH CENTER AT REDBIRD SQUARE
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
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:615-240-3741
Mailing Address - Fax:
Practice Address - Street 1:3107 W CAMP WISDOM RD STE 189
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2638
Practice Address - Country:US
Practice Address - Phone:214-331-2922
Practice Address - Fax:214-331-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007032261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087966001Medicaid
TX490004331Medicare PIN
TXASC052Medicare PIN