Provider Demographics
NPI:1386614832
Name:CARROLL COUNTY DIGESTIVE DISEASE CENTER, LLC
Entity type:Organization
Organization Name:CARROLL COUNTY DIGESTIVE DISEASE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD # L&C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-240-3820
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:216B WASHINGTON HEIGHTS MED CTR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5633
Practice Address - Country:US
Practice Address - Phone:410-857-5113
Practice Address - Fax:410-840-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1245261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD250798OtherMAMSI
MD583381-01OtherCAREFIRST BLUECROSS BLUES
MD0634649OtherCIGNA
MD5624559OtherAETNA
MD68-00074OtherUNITEDHEALTHCARE
MD115559OtherAMERIGROUP
MD47928OtherCOVENTRY HEALTHCARE OF DE
MD57281OtherJOHNS HOPKINS EHP & PP
MD6013104 00Medicaid
MDNE4OtherBLUE CHOICE
MDNE4OtherBLUESHIELD FEDERAL
MDZY44OtherCAREFIRST BCBS SECONDARY
MD0865292OtherAETNA HMO
MD115559OtherAMERIGROUP
MD250798OtherMAMSI
MD0865292OtherAETNA HMO
MD=========OtherFIDELITY BENEFIT ADMIN.