Provider Demographics
NPI:1609190784
Name:FRONTIER HOME MEDICAL, INC
Entity Type:Organization
Organization Name:FRONTIER HOME MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-784-3040
Mailing Address - Street 1:1600 W 13TH ST
Mailing Address - Street 2:PO BOX 396
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1196
Mailing Address - Country:US
Mailing Address - Phone:308-784-3040
Mailing Address - Fax:866-712-3835
Practice Address - Street 1:1600 W 13TH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1196
Practice Address - Country:US
Practice Address - Phone:308-784-3040
Practice Address - Fax:866-712-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1154020008Medicare NSC