Provider Demographics
NPI:1356683379
Name:FIRST COLONY PRIMARY CARE, P.A.
Entity Type:Organization
Organization Name:FIRST COLONY PRIMARY CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHITTALURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-330-5225
Mailing Address - Street 1:1111 HIGHWAY 6
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4914
Mailing Address - Country:US
Mailing Address - Phone:281-494-3460
Mailing Address - Fax:281-494-3463
Practice Address - Street 1:1111 HIGHWAY 6
Practice Address - Street 2:SUITE 130
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4914
Practice Address - Country:US
Practice Address - Phone:281-494-3460
Practice Address - Fax:281-494-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care