NPIMap

Organization Active NPI

FMC Medical Foundation, Inc

Doing business as FMC Canyon

  • Family Medicine Physician
  • Canyon, TX
National Provider Identifier
1619902848
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FMC MEDICAL FOUNDATION, INC
Doing business as
FMC Canyon
Practice address
911 23Rd Street
Canyon, TX 79015-4600
Phone
(806) 655-2104
Fax
(806) 655-0522
NPI assigned
Jul 12, 2006
Last updated
Mar 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stefanie Feemster
Title
Credentialing Specialist
Phone
(806) 358-9400

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

911 23Rd Street
Canyon, TX 79015-4600

Mailing address

911 23Rd Street
Canyon, TX 79015-4600
Phone (806) 655-2104

Other names 2

  • FMC Canyon Doing business as
  • Family Medicine Center Canyon Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
FMC Medical Foundation Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3552 S Soncy Rd
Amarillo, TX 79119
Phone (806) 350-7722

5807 SW 45th Ave
Amarillo, TX 79109
Phone (806) 353-7201

7306 SW 34th Ave
Amarillo, TX 79121

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1619902848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 23RD STREET",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790154600",
            "telephone_number": "806-655-2104",
            "fax_number": "806-655-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 23RD STREET",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790154600",
            "telephone_number": "806-655-2104",
            "fax_number": "806-655-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMC MEDICAL FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "FEEMSTER",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "806-358-9400"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FMC Canyon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medicine Center Canyon",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Canyon, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.