Provider Demographics
NPI:1508493156
Name:FRONTIER PSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:FRONTIER PSYCHIATRY, PLLC
Other - Org Name:AVICENNA, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI GHOMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-200-8471
Mailing Address - Street 1:1601 LEWIS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4182
Mailing Address - Country:US
Mailing Address - Phone:406-200-8471
Mailing Address - Fax:833-465-3766
Practice Address - Street 1:1601 LEWIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4182
Practice Address - Country:US
Practice Address - Phone:406-284-8814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty