=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932353307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRONTIER HOME MEDICAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2008
-----------------------------------------------------
Last Update Date | 10/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 N WEBB RD STE 2
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68803-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-784-3040
-----------------------------------------------------
Fax | 866-560-7431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 N WEBB RD STE 2
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68803-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-784-3040
-----------------------------------------------------
Fax | 866-560-7431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | GREGORY S CORNELIUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-784-3040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------