Healthcare Provider Details

I. General information

NPI: 1861734741
Provider Name (Legal Business Name): FRONTERA HEALTHCARE NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 INDUSTRIAL LOOP STE 2
FREDERICKSBURG TX
78624-5456
US

IV. Provider business mailing address

140 INDUSTRIAL LOOP STE 2
FREDERICKSBURG TX
78624-5456
US

V. Phone/Fax

Practice location:
  • Phone: 325-869-5500
  • Fax:
Mailing address:
  • Phone: 830-992-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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