Healthcare Provider Details

I. General information

NPI: 1013296755
Provider Name (Legal Business Name): FRONTIER HEALTH SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 B STREET SUITE 305
ANCHORAGE AK
99503
US

IV. Provider business mailing address

PO BOX 241889
ANCHORAGE AK
99524-1889
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-6688
  • Fax: 800-556-6916
Mailing address:
  • Phone: 907-751-8138
  • Fax: 807-264-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number6621
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD1521
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DR. ELWIN DAVID HJELLEN
Title or Position: OWNER
Credential: DO
Phone: 907-222-6688