MEDICARE: FRONTIER ACO LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	J6791	TX

General Provider Information

NPI Number	:	1649703224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTIER ACO LLC

Provider Business Mailing Address
First Line	:	8278 BELLAIRE BLVD
Second Line	:	STE A
City	:	HOUSTON
State	:	TX
Zip	:	77036-4090
Country	:	US
Telephone Number	:	713-272-8858
Fax Number	:

Provider Business Practice Location Address
First Line	:	8278 BELLAIRE BLVD
Second Line	:	STE A
City	:	HOUSTON
State	:	TX
Zip	:	77036-4090
Country	:	US
Telephone Number	:	713-272-8858
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAC VU
Credential	:
Telephone Number	:	832-814-2172

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	04/10/2017

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