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General NPI Number Information
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NPI Number | 1235381088
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Entity Type | Organization
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Legal Business Name | FRONTERA HEALTHCARE NETWORK
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 216 W COLLEGE AVE
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City | MASON
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State | TX
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Zip | 76856-3104
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Country | US
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Telephone | 325-347-5926
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Fax | 325-347-5331
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Provider Business Mailing Address
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Address Line | PO BOX 989
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City | EDEN
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State | TX
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Zip | 76837-0989
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Country | US
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Telephone | 325-869-5500
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Fax | 325-869-5692
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MIKKI HAND
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Credential |
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Telephone | 325-869-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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