Healthcare Provider Details

I. General information

NPI: 1619059482
Provider Name (Legal Business Name): AMARILLO HOSPITALIST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S COULTER ST STE 405
AMARILLO TX
79106-1766
US

IV. Provider business mailing address

1301 S COULTER ST STE 405
AMARILLO TX
79106-1766
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-4388
  • Fax: 806-358-3728
Mailing address:
  • Phone: 806-358-4388
  • Fax: 806-358-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NAM LEE
Title or Position: PARTNER
Credential: MD
Phone: 806-358-4388