Healthcare Provider Details

I. General information

NPI: 1467347666
Provider Name (Legal Business Name): FRONTIER CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 GLYNOAKS DR STE 180
LINCOLN NE
68516-6378
US

IV. Provider business mailing address

8333 GLYNOAKS DR STE 180
LINCOLN NE
68516-6378
US

V. Phone/Fax

Practice location:
  • Phone: 402-382-2978
  • Fax: 402-509-8162
Mailing address:
  • Phone: 402-382-2978
  • Fax: 402-509-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP BOUCHER
Title or Position: OWNER
Credential: MD
Phone: 402-382-2978