Provider Demographics
NPI:1437320603
Name:FRIDIE AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:FRIDIE AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRIDIE
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-318-1010
Mailing Address - Street 1:2808 FOUNTAIN PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8031
Mailing Address - Country:US
Mailing Address - Phone:956-318-1010
Mailing Address - Fax:956-381-5857
Practice Address - Street 1:2808 FOUNTAIN PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8031
Practice Address - Country:US
Practice Address - Phone:956-318-1010
Practice Address - Fax:956-381-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4700150001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110401003Medicaid
TX162596401OtherMEDICAID DME
TX110401003Medicaid