Healthcare Provider Details

I. General information

NPI: 1679920763
Provider Name (Legal Business Name): FMC MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SW 14TH AVE STE 100
AMARILLO TX
79101-4140
US

IV. Provider business mailing address

400 SW 14TH AVE STE 100
AMARILLO TX
79101-4140
US

V. Phone/Fax

Practice location:
  • Phone: 806-337-4555
  • Fax: 806-350-5791
Mailing address:
  • Phone: 806-337-4555
  • Fax: 806-337-4551

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: STEVEN GREGORY SMITH
Title or Position: CFO
Credential:
Phone: 806-350-5795