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Organization

NORTHSIDE GASTROENTEROLOGY ENDOSCOPY CENTER LLC

Active
Other names
Northside Gastroenterology Endoscopy Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JEFFREY SNODGRASS (PRESIDENT)
(615) 665-1283
Entity
Organization

Contact information

Practice address
8424 NAAB RD, SUITE 3-G, INDIANAPOLIS, IN 46260-5918
(317) 871-7308
(317) 871-7314
Mailing address
1A BURTON HILLS BLVD, ATTN: L&C, NASHVILLE, TN 37215-6103
(317) 871-7308
(317) 871-7314

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
05-008902
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200119350A
IN
01
490003884
RAILROAD MEDICARE
IN
Enumeration date
02/07/2006
Last updated
04/22/2022
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