Healthcare Provider Details

I. General information

NPI: 1528258555
Provider Name (Legal Business Name): FRONTERA HEALTHCARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 EAKER STREET
EDEN TX
76837-0889
US

IV. Provider business mailing address

P.O. BOX 989
EDEN TX
76837-0989
US

V. Phone/Fax

Practice location:
  • Phone: 325-869-8811
  • Fax: 325-869-5692
Mailing address:
  • Phone: 325-869-5500
  • Fax: 325-869-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. CAM KLEIBRINK
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential: CEO
Phone: 325-869-5500