Provider Demographics
NPI:1013980317
Name:LOS ANGELES-INGLEWOOD ENDOSCOPY LP
Entity Type:Organization
Organization Name:LOS ANGELES-INGLEWOOD ENDOSCOPY LP
Other - Org Name:AIRPORT 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 1:8110 AIRPORT BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3119
Mailing Address - Country:US
Mailing Address - Phone:310-846-4150
Mailing Address - Fax:310-846-4183
Practice Address - Street 1:8110 AIRPORT BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3119
Practice Address - Country:US
Practice Address - Phone:310-846-4150
Practice Address - Fax:310-846-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000964261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-1514Medicaid
CA=========OtherHEALTH NET FEDERAL SERV.
CA05-C0001514Medicare Oscar/Certification