Organization
FMC MEDICAL FOUNDATION, INC
Active
Other names
Panhandle Pediatric Group P A
Organization subpart
No
Provider details
NPI number
Authorized official
STEFANIE FEEMSTER (CREDENTIALING SPECIALIST)
(806) 358-9400
Entity
Organization
Contact information
Practice address
1500 S COULTER ST STE 1, AMARILLO, TX 79106-1787
(806) 354-0404
(806) 354-2810
Mailing address
1500 S COULTER ST STE 1, AMARILLO, TX 79106-1787
(806) 354-0404
(806) 354-2810
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077BM
BCBS
TX
05
—
081138201 TERM 12/16
—
TX
05
—
081138202
—
TX
05
—
081138203
—
TX
05
—
134071303
—
TX
Enumeration date
08/07/2006
Last updated
12/19/2022
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