MEDICARE: FMC HOSPICE - CONROE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012053	OTHER	TX	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265607519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FMC HOSPICE - CONROE LLC

Provider Business Mailing Address
First Line	:	50 N LAURA ST STE 1800
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3614
Country	:	US
Telephone Number	:	904-493-6745
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 NORTH LOOP 336 WEST
Second Line	:	SUITE 324
City	:	CONROE
State	:	TX
Zip	:	77304-3592
Country	:	US
Telephone Number	:	936-788-5900
Fax Number	:	936-788-5902

Authorized Official
Title or Position	:	CFO
Name	:	RICH FOGLE
Credential	:
Telephone Number	:	904-493-6748

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	05/17/2012

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