Provider Demographics
NPI:1003988114
Name:FRONTIER HOSPITALS, INC.
Entity Type:Organization
Organization Name:FRONTIER HOSPITALS, INC.
Other - Org Name:LAKE WHITNEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:954-415-3599
Mailing Address - Street 1:200 N SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2388
Mailing Address - Country:US
Mailing Address - Phone:954-415-3599
Mailing Address - Fax:800-497-3983
Practice Address - Street 1:200 N SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2388
Practice Address - Country:US
Practice Address - Phone:954-415-3599
Practice Address - Fax:800-497-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1440207Q00000X
TX008210282N00000X, 314000000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094136102Medicaid
TX181853601Medicaid
TX000764301Medicaid
TX000764301Medicaid
TX450270Medicare Oscar/Certification
TX00805ZMedicare PIN