Healthcare Provider Details

I. General information

NPI: 1720660582
Provider Name (Legal Business Name): FRONTERA HEALTHCARE NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 COLLEGE ST STE 100
JUNCTION TX
76849-4632
US

IV. Provider business mailing address

PO BOX 989
EDEN TX
76837-0989
US

V. Phone/Fax

Practice location:
  • Phone: 325-770-7676
  • Fax:
Mailing address:
  • Phone: 325-869-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAM KLEIBRINK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 325-869-5500