Organization
FMC MEDICAL FOUNDATION, INC
Active
Other names
FMC Canyon, Family Medicine Center Canyon
Organization subpart
No
Provider details
NPI number
Authorized official
STEFANIE FEEMSTER (CREDENTIALING SPECIALIST)
(806) 358-9400
Entity
Organization
Contact information
Practice address
911 23RD STREET, CANYON, TX 79015-4600
(806) 655-2104
(806) 655-0522
Mailing address
911 23RD STREET, CANYON, TX 79015-4600
(806) 655-2104
(806) 655-0522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D0506538
CLIA
TX
Enumeration date
07/12/2006
Last updated
03/03/2020
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