Provider Demographics
NPI:1285972604
Name:FMC CLINIC LLC
Entity type:Organization
Organization Name:FMC CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-660-2880
Mailing Address - Street 1:8191 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8191 SOUTHWEST FWY
Practice Address - Street 2:SUITE 115
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1709
Practice Address - Country:US
Practice Address - Phone:832-660-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty