Provider Demographics
NPI:1669522249
Name:AMARILLO FAMILY PHYSICIANS CLINIC, P.A.
Entity type:Organization
Organization Name:AMARILLO FAMILY PHYSICIANS CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-359-4701
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-359-4701
Mailing Address - Fax:806-354-0594
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:STE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-359-4701
Practice Address - Fax:806-354-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082377501Medicaid
TXCC5396OtherRAILROAD MEDICARE
TX=========OtherTAX ID
TX082377501Medicaid