Provider Demographics
NPI:1700320702
Name:AMARILLO STAT CARE PLLC
Entity Type:Organization
Organization Name:AMARILLO STAT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-0033
Mailing Address - Street 1:1115 YUCCA DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79108-3709
Mailing Address - Country:US
Mailing Address - Phone:806-231-4353
Mailing Address - Fax:
Practice Address - Street 1:6014 S WESTERN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-3612
Practice Address - Country:US
Practice Address - Phone:806-553-2728
Practice Address - Fax:806-553-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty