Provider Demographics
NPI:1962724336
Name:FRIDIE AND ASSOCIATES, INC
Entity type:Organization
Organization Name:FRIDIE AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:PO BOX 3820
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-3820
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1177213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110401003Medicaid