Provider Demographics
NPI:1447223938
Name:CHATTANOOGA ENDOSCOPY ASC LLC
Entity Type:Organization
Organization Name:CHATTANOOGA ENDOSCOPY ASC LLC
Other - Org Name:CHATTANOOGA 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 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: L&C
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 1:1501 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 117
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-4332
Practice Address - Country:US
Practice Address - Phone:423-698-3999
Practice Address - Fax:423-698-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000098261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288313Medicaid
TN490004372OtherRAILROAD MEDICARE
TN=========OtherHUMANA MILITARY HEALTHCAR
TN=========OtherHUMANA MILITARY HEALTHCAR
TN490004372OtherRAILROAD MEDICARE