Organization
SOUTHFIELD ENDOSCOPY ASC LLC
Active
Other names
Gastrointestinal Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY SNODGRASS (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
264 W MAPLE RD, SUITE 100, TROY, MI 48084-5435
(248) 269-5594
(248) 269-6546
Mailing address
264 W MAPLE RD, SUITE 100, TROY, MI 48084-5435
(248) 269-5594
(248) 269-6546
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
636911
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94321929
TRICARE
MI
Enumeration date
02/10/2006
Last updated
09/21/2022
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