Provider Demographics
NPI:1427368083
Name:FMC MEDICAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:FMC MEDICAL FOUNDATION, INC.
Other - Org Name:FMC GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEEMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-358-9400
Mailing Address - Street 1:2701 S. GEORGIA
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1930
Mailing Address - Country:US
Mailing Address - Phone:806-350-3000
Mailing Address - Fax:806-350-3337
Practice Address - Street 1:2701 S. GEORGIA
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1930
Practice Address - Country:US
Practice Address - Phone:806-350-3000
Practice Address - Fax:806-350-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00248RMedicare UPIN