Provider Demographics
NPI:1619282027
Name:TEXAS COLORECTAL CLINIC PA
Entity Type:Organization
Organization Name:TEXAS COLORECTAL CLINIC PA
Other - Org Name:SUGAR LAND COLON & RECTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SWARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASUBRAMANIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-277-2121
Mailing Address - Street 1:PO BOX 2245
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77252-2245
Mailing Address - Country:US
Mailing Address - Phone:281-277-2121
Mailing Address - Fax:281-277-2125
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 561
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2669
Practice Address - Country:US
Practice Address - Phone:281-277-2121
Practice Address - Fax:281-277-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty