Healthcare Provider Details

I. General information

NPI: 1356797831
Provider Name (Legal Business Name): FMC MEDICAL FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 ROSS OSAGE STREET
AMARILLO TX
79103-3000
US

IV. Provider business mailing address

2329 ROSS OSAGE STREET
AMARILLO TX
79103-3000
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-5790
  • Fax: 806-350-5791
Mailing address:
  • Phone: 806-350-5790
  • Fax: 806-350-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
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: 806-358-9400