Provider Demographics
NPI:1710215637
Name:WESTGLEN ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:WESTGLEN ENDOSCOPY CENTER LLC
Other - Org Name:WESTGLEN ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:16663 MIDLAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-3042
Mailing Address - Country:US
Mailing Address - Phone:913-248-8800
Mailing Address - Fax:913-248-8858
Practice Address - Street 1:16663 MIDLAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-3042
Practice Address - Country:US
Practice Address - Phone:913-248-8800
Practice Address - Fax:913-248-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS900404205OtherMARY SUNSHINE
KS100318050CMedicaid
KS900404202OtherCRNA CHRISTIAN E. JACKSON
KS900404204OtherROBIN R. KROEGER CRNA
KS900404203OtherCRNA MARYELLEN WINTER
KS900404201OtherCRNA JAMES L. MATTINGLY
KS100318050CMedicaid