Healthcare Provider Details

I. General information

NPI: 1194051300
Provider Name (Legal Business Name): FRONTIER MEDICAL DEVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7868 OLD LEMAY FERRY RD
BARNHART MO
63012-1728
US

IV. Provider business mailing address

7868 OLD LEMAY FERRY RD
BARNHART MO
63012-1728
US

V. Phone/Fax

Practice location:
  • Phone: 314-363-7960
  • Fax:
Mailing address:
  • Phone: 314-363-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DERRICK SHAWN NASH
Title or Position: PRESIDEN
Credential:
Phone: 314-363-7960