Provider Demographics
NPI:1578756771
Name:FMC CLINICS, P.A.
Entity Type:Organization
Organization Name:FMC CLINICS, P.A.
Other - Org Name:DBA LIVING WELL EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CORPORATE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-355-8900
Mailing Address - Street 1:5807 SW 45TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5205
Mailing Address - Country:US
Mailing Address - Phone:806-355-2900
Mailing Address - Fax:806-355-2929
Practice Address - Street 1:5807 SW 45TH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5205
Practice Address - Country:US
Practice Address - Phone:806-355-2900
Practice Address - Fax:806-355-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213058501Medicaid
TX00Y419Medicare UPIN
TX213058501Medicaid