Healthcare Provider Details

I. General information

NPI: 1194881623
Provider Name (Legal Business Name): FRONTIER HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 US HIGHWAY 23N
WEBER CITY VA
24290
US

IV. Provider business mailing address

PO BOX 9054 1167 SPRATLIN PARK DRIVE
GRAY TN
37615-9054
US

V. Phone/Fax

Practice location:
  • Phone: 276-225-0976
  • Fax: 423-467-3644
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number315-16-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number315-07-004
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number315-05-001
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number315-03-001
License Number StateVA

VIII. Authorized Official

Name: CRISTI LYNN BLALOCK
Title or Position: DIRECTOR OF CONTRACTING/ COMPLIANCE
Credential: MBA
Phone: 423-467-3741