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General NPI Number Information
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NPI Number | 1619902848
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Entity Type | Organization
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Legal Business Name | FMC MEDICAL FOUNDATION, INC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 911 23RD STREET
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City | CANYON
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State | TX
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Zip | 79015-4600
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Country | US
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Telephone | 806-655-2104
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Fax | 806-655-0522
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Provider Business Mailing Address
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Address Line | 911 23RD STREET
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City | CANYON
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State | TX
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Zip | 79015-4600
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Country | US
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Telephone | 806-655-2104
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Fax | 806-655-0522
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | STEFANIE FEEMSTER
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Credential |
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Telephone | 806-358-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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