Provider Demographics
NPI:1083041958
Name:FBC HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:FBC HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTI
Authorized Official - Middle Name:I
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-261-7202
Mailing Address - Street 1:5201 HIGHWAY 6 STE 800
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4379
Mailing Address - Country:US
Mailing Address - Phone:281-261-7202
Mailing Address - Fax:281-261-7220
Practice Address - Street 1:5201 HIGHWAY 6 STE 800
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4379
Practice Address - Country:US
Practice Address - Phone:281-261-7202
Practice Address - Fax:281-261-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX336172Medicare PIN