Provider Demographics
NPI:1164414447
Name:EAST VALLEY ENDOSCOPY LLC
Entity Type:Organization
Organization Name:EAST VALLEY ENDOSCOPY 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:615-665-1283
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:6020 E ARBOR AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6102
Practice Address - Country:US
Practice Address - Phone:480-830-2005
Practice Address - Fax:480-830-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC3368261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5441198OtherCCN
AZAZ0208590OtherBLUE CROSS BLUE SHEILD
AZIZ9438OtherHEALTHNET
AZ68-03446OtherEVERCARE CHOICE
AZ769862OtherAHCCCS
AZ5166126-001OtherCIGNA
AZ0020884OtherPHYSICIANHEALTHORGANIZATI
AZA-133702OtherMULTIPLAN
AZ2047910OtherFIRST HEALTH NETWORK
AZ874634OtherUSA/MCO
AZAZ0208590OtherTRIWEST
AZAZ0208590OtherTRIWEST
AZAZ0208590OtherBLUE CROSS BLUE SHEILD
AZ490005754Medicare ID - Type UnspecifiedRAILROAD MEDICARE