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	251C00000X	Developmentally Disabled Services Day Training Agency	L (20)24M6-076-1413	TN
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	L (20)24M6-076-1413	TN

General Provider Information

NPI Number	:	1922164599
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	:	1135 VOLUNTEER PKWY STE 14
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-4658
Country	:	US
Telephone Number	:	423-878-1600
Fax Number	:	423-878-1606

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MRS. KRISTIE HAMMONDS
Credential	:
Telephone Number	:	423-467-3600

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/14/2021

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