Healthcare Provider Details

I. General information

NPI: 1427368083
Provider Name (Legal Business Name): FMC MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S. GEORGIA
AMARILLO TX
79109-1930
US

IV. Provider business mailing address

2701 S. GEORGIA
AMARILLO TX
79109-1930
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-3000
  • Fax: 806-350-3337
Mailing address:
  • Phone: 806-350-3000
  • Fax: 806-350-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: STEFANIE FEEMSTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 806-358-9400