Provider Demographics
NPI:1770190191
Name:FIRST CARE COLLABORATIVE PLLC
Entity Type:Organization
Organization Name:FIRST CARE COLLABORATIVE PLLC
Other - Org Name:FIRST CARE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-483-6401
Mailing Address - Street 1:4053 TAYLOR RD STE K
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5526
Mailing Address - Country:US
Mailing Address - Phone:757-483-6401
Mailing Address - Fax:757-686-3025
Practice Address - Street 1:4053 TAYLOR RD STE K
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5526
Practice Address - Country:US
Practice Address - Phone:757-483-6401
Practice Address - Fax:757-686-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty