# SOUTH BEND IN ENDOSCOPY ASC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Michiana Endoscopy Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427051796
- **Authorized official:** MR. JEFFREY SNODGRASS (PRESIDENT)
- **Authorized official phone:** (615) 665-1283

## Contact information

- **Practice address:** 53830 GENERATIONS DR, SOUTH BEND, IN 46635-1557
- **Practice address phone:** (574) 271-0893
- **Practice address fax:** (574) 271-4362
- **Mailing address:** 1A BURTON HILLS BLVD, ATTN: L&C, NASHVILLE, TN 37215-6103
- **Mailing address phone:** (574) 271-0893
- **Mailing address fax:** (574) 271-4362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 17-009761-1 | IN | Yes |
| 261QE0800X | Endoscopy Clinic/Center | 010076 | IN | — |

## Other

- **Enumeration date:** 05/31/2005
- **Last updated:** 06/28/2022