Provider Demographics
NPI:1932569365
Name:AMARILLO FAMILY CARE CLINIC PLLC
Entity Type:Organization
Organization Name:AMARILLO FAMILY CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:806-236-6274
Mailing Address - Street 1:PO BOX 32121
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79120-2121
Mailing Address - Country:US
Mailing Address - Phone:806-236-6274
Mailing Address - Fax:
Practice Address - Street 1:17401 FM 2575
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79108-8053
Practice Address - Country:US
Practice Address - Phone:806-236-6274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3284226Medicaid
TX325681ZHHLMedicare PIN