MEDICARE: FORT BEND FAMILY HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1104031210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT BEND FAMILY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	400 AUSTIN ST
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4406
Country	:	US
Telephone Number	:	281-342-4530
Fax Number	:	281-342-3832

Provider Business Practice Location Address
First Line	:	2407 N RICHMOND RD
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-2403
Country	:	US
Telephone Number	:	979-532-8755
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LYNDA BIBLE
Credential	:
Telephone Number	:	281-342-4530

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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