Provider Demographics
NPI:1427017813
Name:WESTERN WASHINGTON ENDOSCOPY CENTERS LLC
Entity Type:Organization
Organization Name:WESTERN WASHINGTON ENDOSCOPY CENTERS LLC
Other - Org Name:PENINSULA ENDOSCOPY CENTER
Other - Org Type:Doing Business As
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:PO BOX 2157
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-2157
Mailing Address - Country:US
Mailing Address - Phone:253-858-8144
Mailing Address - Fax:253-858-7818
Practice Address - Street 1:2727 HOLLYCROFT ST
Practice Address - Street 2:SUITE 480
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1305
Practice Address - Country:US
Practice Address - Phone:253-858-8144
Practice Address - Fax:253-858-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACON 1299 REQUIRED261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7127103Medicaid
WA7127103Medicaid
WA8851597Medicare PIN