1043680887 NPI number — FRED'S INC

Table of content: (NPI 1043680887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043680887 NPI number — FRED'S INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRED'S INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043680887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70441-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-222-6125
Provider Business Mailing Address Fax Number:
225-222-6197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6216 HIGHWAY 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-222-6125
Provider Business Practice Location Address Fax Number:
225-222-6197
Provider Enumeration Date:
10/06/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUDAK
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH CARE MANAGER
Authorized Official Telephone Number:
800-374-7417

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  016776 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1936472 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".