Provider Demographics
NPI:1265607519
Name:FMC HOSPICE - CONROE LLC
Entity type:Organization
Organization Name:FMC HOSPICE - CONROE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-493-6748
Mailing Address - Street 1:50 N LAURA ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3614
Mailing Address - Country:US
Mailing Address - Phone:904-493-6745
Mailing Address - Fax:
Practice Address - Street 1:2040 NORTH LOOP 336 WEST
Practice Address - Street 2:SUITE 324
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3592
Practice Address - Country:US
Practice Address - Phone:936-788-5900
Practice Address - Fax:936-788-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012053OtherSTATE LICENSE
TX001017834Medicaid
TX012053OtherSTATE LICENSE