Provider Demographics
NPI:1447445887
Name:FRED HEALTH CARE P L L C
Entity type:Organization
Organization Name:FRED HEALTH CARE P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.A. MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:409-429-9494
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:FRED
Mailing Address - State:TX
Mailing Address - Zip Code:77616-0337
Mailing Address - Country:US
Mailing Address - Phone:409-980-9457
Mailing Address - Fax:
Practice Address - Street 1:20290 FM 92
Practice Address - Street 2:
Practice Address - City:FRED
Practice Address - State:TX
Practice Address - Zip Code:77616-0337
Practice Address - Country:US
Practice Address - Phone:409-980-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 01322261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS09777Medicare UPIN