Healthcare Provider Details

I. General information

NPI: 1376462358
Provider Name (Legal Business Name): FRONTIER LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W HARGETT ST STE 301
RALEIGH NC
27601-1351
US

IV. Provider business mailing address

3510 WESLEY POINT DR
BROWNS SUMMIT NC
27214-9892
US

V. Phone/Fax

Practice location:
  • Phone: 346-396-1252
  • Fax:
Mailing address:
  • Phone: 346-396-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JALEN CONRAD MARTIN
Title or Position: MANAGING MEMBER
Credential:
Phone: 346-396-1252