MEDICARE: FRONTIER HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	315	TN

General Provider Information

NPI Number	:	1235298720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTIER HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 9054
Second Line	:
City	:	GRAY
State	:	TN
Zip	:	37615-9054
Country	:	US
Telephone Number	:	423-467-3600
Fax Number	:	423-467-3644

Provider Business Practice Location Address
First Line	:	210 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4630
Country	:	US
Telephone Number	:	423-232-4326
Fax Number	:	423-232-4255

Authorized Official
Title or Position	:	DIRECTOR CONTRACTING/ COMPLIANCE
Name	:	CRISTI L BLALOCK
Credential	:	MBA
Telephone Number	:	423-467-3741

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/01/2025

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Directions to “FRONTIER HEALTH ” Practice Location

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