Healthcare Provider Details

I. General information

NPI: 1235381088
Provider Name (Legal Business Name): FRONTERA HEALTHCARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W COLLEGE AVE
MASON TX
76856-3104
US

IV. Provider business mailing address

PO BOX 989
EDEN TX
76837-0989
US

V. Phone/Fax

Practice location:
  • Phone: 325-347-5926
  • Fax: 325-347-5331
Mailing address:
  • Phone: 325-869-5500
  • Fax: 325-869-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MIKKI HAND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 325-869-5500