Provider Demographics
NPI:1104932714
Name:FRIONA MEDICAL CLINIC, P.A.
Entity type:Organization
Organization Name:FRIONA MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-250-2781
Mailing Address - Street 1:1307 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRIONA
Mailing Address - State:TX
Mailing Address - Zip Code:79035-1121
Mailing Address - Country:US
Mailing Address - Phone:806-250-2781
Mailing Address - Fax:806-250-2088
Practice Address - Street 1:1307 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FRIONA
Practice Address - State:TX
Practice Address - Zip Code:79035-1121
Practice Address - Country:US
Practice Address - Phone:806-250-2781
Practice Address - Fax:806-250-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0948457-01Medicaid
TX0948457-01Medicaid