Healthcare Provider Details

I. General information

NPI: 1558685644
Provider Name (Legal Business Name): FRONTIER HOME MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S COTTONWOOD ST
NORTH PLATTE NE
69101-7789
US

IV. Provider business mailing address

1320 S COTTONWOOD ST
NORTH PLATTE NE
69101-7789
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-3040
  • Fax: 866-712-3835
Mailing address:
  • Phone: 308-784-3040
  • Fax: 866-712-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY CORNELIUS
Title or Position: PRESIDENT
Credential:
Phone: 308-784-3040