Healthcare Provider Details

I. General information

NPI: 1285972604
Provider Name (Legal Business Name): FMC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 SOUTHWEST FWY SUITE 115
HOUSTON TX
77074-1709
US

IV. Provider business mailing address

8191 SOUTHWEST FWY SUITE 115
HOUSTON TX
77074-1709
US

V. Phone/Fax

Practice location:
  • Phone: 832-660-2880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STELLA THOMPSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-660-2880