Provider Demographics
NPI:1609864883
Name:EASTERN CONNECTICUT ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:615-240-3820
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-7800
Practice Address - Fax:860-886-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
CT0295261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373165OtherAETNA PHMO POS
351OtherBCBS FEDERAL
CT490004614OtherMEDICARE RAILROAD
2373165OtherAETNA PPO EPO NAP MC
765560OtherCONNECTICARE
351OtherBCBS CT
351OtherNBC NATIONAL
A2114853OtherOXFORD
IV9845OtherHEALTH NET
2373165OtherUSHC AETNA US HEALTH CARE
IV9845OtherHEALTH NET