Provider Demographics
NPI:1568070142
Name:FRONTIER MEDICAL ASSOCIATES OF PAINTSVILLE INC
Entity Type:Organization
Organization Name:FRONTIER MEDICAL ASSOCIATES OF PAINTSVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANTOIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-372-1234
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0280
Mailing Address - Country:US
Mailing Address - Phone:606-372-1234
Mailing Address - Fax:606-372-1240
Practice Address - Street 1:713 BROADWAY ST STE 301B
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1465
Practice Address - Country:US
Practice Address - Phone:606-372-1234
Practice Address - Fax:606-372-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100690460Medicaid
KY7100689940Medicaid
KY7100690030Medicaid
KY7100690060Medicaid
KY7100690430Medicaid