Provider Demographics
NPI:1164105599
Name:CLOVIS ENDOSCOPY ASC, LLC
Entity Type:Organization
Organization Name:CLOVIS ENDOSCOPY ASC, LLC
Other - Org Name:CLOVIS 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:
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:LICENSURE AND CERT DEPT
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-263-4011
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:501 N MEDICAL CENTER DR E STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-9211
Practice Address - Country:US
Practice Address - Phone:559-797-9290
Practice Address - Fax:615-234-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical