Provider Demographics
NPI:1689699571
Name:FRED J FRICKE MD AND ASSOCIATES
Entity Type:Organization
Organization Name:FRED J FRICKE MD AND ASSOCIATES
Other - Org Name:NEVADA GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-738-0500
Mailing Address - Street 1:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-1598
Mailing Address - Country:US
Mailing Address - Phone:775-735-0500
Mailing Address - Fax:775-738-0555
Practice Address - Street 1:247 BLUFFS AVE STE 102
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2488
Practice Address - Country:US
Practice Address - Phone:775-738-0500
Practice Address - Fax:775-738-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3167207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016010Medicaid
NV002016010Medicaid