Provider Demographics
NPI:1093845588
Name:MANFRED & ASSOCIATES, PA
Entity Type:Organization
Organization Name:MANFRED & ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-634-4244
Mailing Address - Street 1:3106 S W S YOUNG DR STE A103
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2007
Mailing Address - Country:US
Mailing Address - Phone:254-634-4244
Mailing Address - Fax:254-634-8809
Practice Address - Street 1:3901 E STAN SCHLUETER LOOP STE 202
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4554
Practice Address - Country:US
Practice Address - Phone:254-634-4244
Practice Address - Fax:254-634-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ41272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165719901Medicaid
00853WMedicare PIN