Healthcare Provider Details

I. General information

NPI: 1801422092
Provider Name (Legal Business Name): FORT BEND FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AUSTIN ST
RICHMOND TX
77469-4406
US

IV. Provider business mailing address

400 AUSTIN ST
RICHMOND TX
77469-4498
US

V. Phone/Fax

Practice location:
  • Phone: 281-342-4530
  • Fax: 281-633-3192
Mailing address:
  • Phone: 281-342-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ROCKY DOTSON
Title or Position: CEO
Credential:
Phone: 281-633-3170