Provider Demographics
NPI:1205923687
Name:FORT BEND COUNTY CLINICAL HEALTH SERVICES
Entity type:Organization
Organization Name:FORT BEND COUNTY CLINICAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-238-3548
Mailing Address - Street 1:4520 READING RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2133
Mailing Address - Country:US
Mailing Address - Phone:281-342-6414
Mailing Address - Fax:281-342-7371
Practice Address - Street 1:4520 READING RD STE A
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2133
Practice Address - Country:US
Practice Address - Phone:281-342-6414
Practice Address - Fax:281-342-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1886251K00000X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2967606Medicaid
TXPH0787Medicare PIN