Organization
DIAGNOSTIC ENDOSCOPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY SNODGRASS (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
778 LONG RIDGE RD, STAMFORD, CT 06902-1227
(203) 322-2400
(203) 329-8855
Mailing address
1A BURTON HILLS BLVD # L&C, NASHVILLE, TN 37215-6187
(615) 240-3820
(615) 234-1720
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0301
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07A
BLUE CROSS/BLUE SHIELD ID
—
01
—
7189280
AETNA ID #
—
01
—
747394
CONNECTICARE ID #
—
01
—
A2535749
OXFORD ID #
—
01
—
IV8574
HEALTHNET ID #
—
Enumeration date
09/19/2005
Last updated
08/09/2022
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