Provider Demographics
NPI:1467447854
Name:FMC - LUBBOCK LLC
Entity Type:Organization
Organization Name:FMC - LUBBOCK LLC
Other - Org Name:BSA HOSPICE OF THE SOUTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-356-0026
Mailing Address - Street 1:5211 SW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4120
Mailing Address - Country:US
Mailing Address - Phone:806-356-0026
Mailing Address - Fax:806-358-3114
Practice Address - Street 1:5211 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4120
Practice Address - Country:US
Practice Address - Phone:806-356-0026
Practice Address - Fax:806-358-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009721OtherSTATE LICENSE
TX001013547Medicaid
TX671501Medicare Oscar/Certification