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General NPI Number Information
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NPI Number | 1588116743
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Entity Type | Organization
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Legal Business Name | FIRST COLONY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 600 FERRIS AVENUE STE B
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City | WAXAHACHIE
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State | TX
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Zip | 75165-6246
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Country | US
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Telephone | 972-636-5727
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Fax |
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Provider Business Mailing Address
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Address Line | 811 S CENTRAL EXPY STE 103
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City | RICHARDSON
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State | TX
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Zip | 75080-7439
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Country | US
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Telephone | 972-636-5727
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JAMAL OTULA
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Credential |
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Telephone | 972-636-5727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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