Healthcare Provider Details

I. General information

NPI: 1578756771
Provider Name (Legal Business Name): FMC CLINICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5807 SW 45TH AVENUE SUITE 100
AMARILLO TX
79109-5205
US

IV. Provider business mailing address

5807 SW 45TH AVENUE SUITE 100
AMARILLO TX
79109-5205
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-2900
  • Fax: 806-355-2929
Mailing address:
  • Phone: 806-355-2900
  • Fax: 806-355-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN SUE HURT
Title or Position: DIRECTOR, CORPORATE CREDENTIALING
Credential:
Phone: 806-355-8900