Healthcare Provider Details

I. General information

NPI: 1013276088
Provider Name (Legal Business Name): FMC MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7306 SW 34TH AVE UNIT 4
AMARILLO TX
79121-1423
US

IV. Provider business mailing address

7306 SW 34TH AVE UNIT 4
AMARILLO TX
79121-1423
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-8850
  • Fax: 806-350-8855
Mailing address:
  • Phone: 806-350-8850
  • Fax: 806-350-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN GREGORY SMITH
Title or Position: CFO
Credential:
Phone: 806-350-5795