Provider Demographics
NPI:1497751747
Name:MID-ATLANTIC ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:MID-ATLANTIC ENDOSCOPY CENTER, LLC
Other - Org Name:MID-ATLANTIC GASTROINTESTINAL CENTER II
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 1:20 BURTON HILLS BLVD.
Mailing Address - Street 2:SUITE 500, ATTN: L&C
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6176
Mailing Address - Country:US
Mailing Address - Phone:615-665-1283
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:4923 OGLETOWN STANTON RD
Practice Address - Street 2:STE 100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2081
Practice Address - Country:US
Practice Address - Phone:302-993-0310
Practice Address - Fax:302-993-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1549OtherAMERIHEALTH
177A41OtherBLUE CROSS OF DELEWARE
DE1000022924Medicaid
DE1000022924Medicaid