| Organization Name: | TEDDIE JOE SNODGRASS, INC. |
| NPI Number: | 1003272386 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TEDDIE JOE SNODGRASS (PRESIDENT) |
| Mailing Address: | 94-552 Polina Pl Waipahu |
| State: | HI US |
| Postal Code: | 967975800 |
| Phone Number: | 8083427843 |
| Fax Number: | 8663231118 |
| NPI Enumeration Date: | 01/03/2016 |
| NPI Last Update Date: | 01/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |