Provider Demographics
NPI:1285613414
Name:FRED MATHEWS INC.
Entity type:Organization
Organization Name:FRED MATHEWS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:563-568-6004
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-0008
Mailing Address - Country:US
Mailing Address - Phone:563-568-6004
Mailing Address - Fax:563-568-6139
Practice Address - Street 1:40 1ST ST SE
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-2022
Practice Address - Country:US
Practice Address - Phone:563-568-6004
Practice Address - Fax:563-568-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16397OtherBLUE CROSS/BLUE SHIELD
IA0163972Medicaid
IA0163972Medicaid