1386614832 NPI number — CARROLL COUNTY DIGESTIVE DISEASE CENTER, LLC

Table of content: (NPI 1386614832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386614832 NPI number — CARROLL COUNTY DIGESTIVE DISEASE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARROLL COUNTY DIGESTIVE DISEASE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARROLL COUNTY DIGESTIVE DISEASE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386614832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1A BURTON HILLS BLVD # L&C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-240-3820
Provider Business Mailing Address Fax Number:
615-234-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216B WASHINGTON HEIGHTS MED CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-857-5113
Provider Business Practice Location Address Fax Number:
410-840-8344
Provider Enumeration Date:
01/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SNODGRASS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QE0800X , with the licence number:  A1245 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250798 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 583381-01 . This is a "CAREFIRST BLUECROSS BLUES" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0634649 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5624559 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 68-00074 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 115559 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 47928 . This is a "COVENTRY HEALTHCARE OF DE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 57281 . This is a "JOHNS HOPKINS EHP & PP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6013104 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: NE4 . This is a "BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: NE4 . This is a "BLUESHIELD FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: ZY44 . This is a "CAREFIRST BCBS SECONDARY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0865292 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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