Provider Demographics
NPI:1639579162
Name:FRONTIER MEDICAL & BEHAVIORAL CENTER INC
Entity Type:Organization
Organization Name:FRONTIER MEDICAL & BEHAVIORAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:NWANNA
Authorized Official - Last Name:NWOKIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-750-2438
Mailing Address - Street 1:5105 CAMINO AL NORTE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2373
Mailing Address - Country:US
Mailing Address - Phone:702-750-2438
Mailing Address - Fax:702-750-2173
Practice Address - Street 1:5105 CAMINO AL NORTE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2373
Practice Address - Country:US
Practice Address - Phone:702-750-2438
Practice Address - Fax:702-750-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty