Fred Health Care P L L C
Organization Active NPI Rural Health Clinic/Center · Fred, TX
NPI 1447445887 · NPPES record last updated Mar 31, 2011
Key facts
- NPI
- 1447445887
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- PA 01322 (TX)
- Legal business name
- FRED HEALTH CARE P L L C
- Practice address
- 20290 FM 92
Fred, TX 77616-0337 - Phone
- (409) 980-9457
- NPI assigned
- Sep 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Kim Donald Best, P.A.
- Title
- P.a. Manager
- Phone
- (409) 429-9494
Owners & managing parties with NPI records 1
-
Kim Donald Best, P.A. CW-2 RET
Other NPIs on the same Medicare enrollment 1
Practitioners 1
-
Kim Donald Best, P.A. CW-2 RET
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Rural health clinic certification: CCN 673899
- Legal name
- FRED HEALTH CARE P L L C
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 21, 2007
- Last certification
- Jan 14, 2020
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 24, 2006 in TX
- Enrollment address
- 20290 FM 92 South
Fred, TX 77616-9527
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Kim D Best |
5% Or Greater Direct Ownership Interest | Apr 15, 2006 | 49% |
| Deborah Best |
5% Or Greater Direct Ownership Interest | Apr 15, 2006 | 51% |
| W-2 Managing Employee | Apr 15, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061101000197 | TX | Part a Provider - Rural Health Clinic | 4183628555 |
1 other NPI on this enrollment Practice locations: Fred, TX |
National Provider Directory
Locations
20290 FM 92 S
Fred, TX 77616
Phone (409) 429-9494
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | PA 01322 | TX | Yes |
Addresses
Primary practice location
20290 FM 92
Fred, TX 77616-0337
Mailing address
PO Box 337
Fred, TX 77616-0337
Phone (409) 980-9457
Other providers in Fred, TX
All providers in Fred, TX · Rural Health Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.