Provider Demographics
NPI:1821285073
Name:GLENDORA CA ENDOSCOPY ASC LP
Entity Type:Organization
Organization Name:GLENDORA CA ENDOSCOPY ASC LP
Other - Org Name:GLENDORA DIGESTIVE DISEASE INSTITUTE
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 1:1794 S BARRANCA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5421
Mailing Address - Country:US
Mailing Address - Phone:626-858-4600
Mailing Address - Fax:626-858-4601
Practice Address - Street 1:1794 S BARRANCA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5421
Practice Address - Country:US
Practice Address - Phone:626-858-4600
Practice Address - Fax:626-858-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05C0001673Medicare Oscar/Certification
CA05C1673Medicare PIN