Healthcare Provider Details

I. General information

NPI: 1467447854
Provider Name (Legal Business Name): FMC - LUBBOCK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 SW 9TH AVE
AMARILLO TX
79106-4120
US

IV. Provider business mailing address

5211 SW 9TH AVE
AMARILLO TX
79106-4120
US

V. Phone/Fax

Practice location:
  • Phone: 806-356-0026
  • Fax: 806-358-3114
Mailing address:
  • Phone: 806-356-0026
  • Fax: 806-358-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN N. RILEY
Title or Position: OWNER/PARTNER
Credential:
Phone: 806-356-0026