Healthcare Provider Details

I. General information

NPI: 1649205972
Provider Name (Legal Business Name): FMC MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/03/2022
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S. COULTER SUITE 6
AMARILLO TX
79106-1790
US

IV. Provider business mailing address

1500 S. COULTER SUITE 6
AMARILLO TX
79106-1790
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-9777
  • Fax: 806-467-9799
Mailing address:
  • Phone: 806-467-9777
  • Fax: 806-467-9799

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: STEFANIE FEEMSTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 806-350-7325