Provider Demographics
NPI:1588116743
Name:FIRST COLONY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:FIRST COLONY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OTULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-636-5727
Mailing Address - Street 1:811 S CENTRAL EXPY STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7439
Mailing Address - Country:US
Mailing Address - Phone:972-636-5727
Mailing Address - Fax:
Practice Address - Street 1:600 FERRIS AVENUE
Practice Address - Street 2:STE B
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-6246
Practice Address - Country:US
Practice Address - Phone:972-636-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical