Organization
SOUTH BEND IN ENDOSCOPY ASC LLC
Active
Other names
Michiana Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY SNODGRASS (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
53830 GENERATIONS DR, SOUTH BEND, IN 46635-1557
(574) 271-0893
(574) 271-4362
Mailing address
1A BURTON HILLS BLVD, ATTN: L&C, NASHVILLE, TN 37215-6103
(574) 271-0893
(574) 271-4362
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
17-009761-1
IN
261QE0800X
Endoscopy Clinic/Center
010076
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000098200
BLUE CROSS INDIANA
IN
05
—
200156540
—
IN
Enumeration date
05/31/2005
Last updated
06/28/2022
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