MEDICARE: FRONTIER MEDICAL & BEHAVIORAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
2	2084F0202X	Forensic Psychiatry Physician
3	2084P0804X	Child & Adolescent Psychiatry Physician
4	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1639579162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTIER MEDICAL & BEHAVIORAL CENTER INC

Provider Business Mailing Address
First Line	:	5105 CAMINO AL NORTE
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2373
Country	:	US
Telephone Number	:	702-750-2438
Fax Number	:	702-750-2173

Provider Business Practice Location Address
First Line	:	5105 CAMINO AL NORTE
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2373
Country	:	US
Telephone Number	:	702-750-2438
Fax Number	:	702-750-2173

Authorized Official
Title or Position	:	OWNER
Name	:	JEROME NWANNA NWOKIKE
Credential	:	M.D.
Telephone Number	:	702-750-2438

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/27/2016

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Directions to “FRONTIER MEDICAL & BEHAVIORAL CENTER INC ” Practice Location

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