Provider Demographics
NPI:1821269713
Name:FORT BEND CHILDREN'S CLINIC
Entity Type:Organization
Organization Name:FORT BEND CHILDREN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-499-1855
Mailing Address - Street 1:4646 RIVERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6141
Mailing Address - Country:US
Mailing Address - Phone:281-499-1855
Mailing Address - Fax:281-499-1585
Practice Address - Street 1:4646 RIVERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6141
Practice Address - Country:US
Practice Address - Phone:281-499-1855
Practice Address - Fax:281-499-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center