Healthcare Provider Details

I. General information

NPI: 1700320702
Provider Name (Legal Business Name): AMARILLO STAT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6014 S WESTERN ST SUITE 400
AMARILLO TX
79110-3612
US

IV. Provider business mailing address

1115 YUCCA DR
AMARILLO TX
79108-3709
US

V. Phone/Fax

Practice location:
  • Phone: 806-553-2728
  • Fax: 806-553-2872
Mailing address:
  • Phone: 806-231-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRYAN LEE WILLIAMS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 806-771-0033