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General NPI Number Information
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NPI Number | 1629949284
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Entity Type | Organization
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Legal Business Name | FRONTLINE TELEHEALTH
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 3211 OAKMONT BLVD
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City | AUSTIN
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State | TX
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Zip | 78703-1345
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Country | US
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Telephone | 512-225-5024
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Fax | 833-605-4025
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Provider Business Mailing Address
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Address Line | PO BOX 178
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City | HUTTO
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State | TX
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Zip | 78634-0178
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Country | US
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Telephone | 512-225-5024
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Fax | 833-605-4025
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Authorized Official
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Title or Position | MANAGER
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Name | MATTHEW TYRRELL BURRUS
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Credential | MD
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Telephone | 409-284-1927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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